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A TREATISE 



ON 



INDIGESTION. 



WITH 



OBSERVATIONS 



SOME PAINFUL COMPLAINTS ORIGINATING IN INDIGESTION, 
AS TIC DOULOUREUX, NERVOUS DISORDER, &c. 



BY 

THOMAS J. GRAHAM, 

OF THE UNIVERSITY OF GLASGOW ; AND THE ROYAL COLLEGE OF SURGEONS, 

LONDON, &C. 



JFivnt glmnrfcan, 

FROM THE LAST LONDON EDITION REVISED AND ENLARGED: 

WITH 

NOTES 5 AND AN APPENDIX, 

Containing Observations relative to the mode of treating Dyspepsia lately adopted 
and recommended by Dr Avery, Mr Halstead, and others ; 

BY AN AMERICAN PHYSICIAN. 



t 



KEY AND MIELKE, 181 MARKET STREET. 
Printed by James Kay, Jun. <fy Co. 

1831. 






" He wanted no other recommendation for any one article of science, than 
the recommendation of evidence — and, with this recommendation, he opened 
to it the chamber of his mind, though authority scowled upon it, and taste 
was disgusted by it, and fashion was ashamed of it." 

Br Chalmers — On the Merits of Newton's Philosophy. 



Entered according to the act of congress, in the year 1831, by Key and Mielke, 
in the Clerk's office of the District Court of the Eastern District of Penn- 
sylvania. 



PREFACE 



TO 



THE FIRST EDITION 



The liver is a gland of waste ; the stomach and 
small intestines are organs of supply — (a supply of 
the most important and imperious nature): the 
former is an insensible viscus, comparatively 
speaking, loosely connected with the other abdo- 
minal viscera, and with the general habit ; the lat- 
ter are organs of elevated sensibility, not only 
intimately associated with every part of the system, 
but themselves forming the chief viscera of the 
abdomen; and with their blood-vessels, nerves and 
membranes making up the great bulk of this cavity. 
From this, I believe, we rightly infer, that the 
liver is an organ in the animal economy of far in- 
ferior importance to the digestive tube; and I 
maintain, that its disorders are by no means to be 
compared with those of the extensive surface of 
this canal, either in frequency, or severity, or con- 
sequence to the welfare of the constitution, A 



IV PREFACE. 

principal object of the following observations is to 
enquire into the evidences of this fact, and to show, 
that the organization, vital properties, functions, 
and sympathies, of this canal, when contrasted with 
those of the liver, tend to prove, that what are 
commonly called "liver and bilious complaints" 
are, nine times out of ten, in reality affections of 
the stomach or bowels, — and, that combined with 
a consideration of the symptoms, and effects of re- 
medies, the above circumstances become irresisti- 
bly convincing of the truth of this assertion. 

My attention was early excited towards ascer- 
taining the correct pathology of those maladies, so 
generally named "liver complaints" from a per- 
suasion, that, in the nature of things, disordered or 
diseased liver is not likely to be, in any degree, so 
often met with, or of such consequence, as disorder 
of the functions of the alimentary canal, — that 
centre of sympathies, to which we are incessantly 
and immediately applying stimulants and irritants, 
so numerous and dissimilar \ and from finding, that 
when these evils were treated in the too common 
way, with active mercurials, they never failed to 
increase instead of disappearing, being not seldom 
confirmed, so that the parts affected ever after re- 
mained debilitated, and subject to frequent disor- 
der : whereas, a different treatment directed, in the 
first instance, towards restoring the impaired ener- 



PREFACE. 



gies, and healthy secretions of the digestive tube, 
rarely failed to remove all complaint. It is not a 
little singular, that the sentiments of Mr Abernethy 
and Dr Hamilton, in regard to the paramount fre- 
quency of disorders of the stomach and bowels, 
and the effectual relief to be obtained in them from 
the exhibition of mild aperients and alteratives, 
should have gained such general confidence among 
medical men, when their practice is so seldom and 
imperfectly followed, especially that of the former 
writer ; the liver still being harped upon continu- 
ally, as bearing the onus of disease, and calomel ac- 
cordingly administered with an unsparing hand. 

The light thrown upon the subject of the first 
part of this treatise by morbid anatomy has been 
draw T n exclusively from the records of dissections, 
contained in the writings of men of professional 
eminence, rather than from any cases and exami- 
nations of my own ; because those records are be- 
fore the public, and as the dissections they describe 
were not instituted to serve my purpose, they will 
with justice be received as more satisfactory and 
conclusive than any I might produce from my own 
practice. 

Though I consider that mercurial preparations 
are extensively exhibited in such doses, and for so 
great a length of time, as constitute them active 
poisons rather than remedies ; yet, let it be remem- 

B 



VI PREFACE. 

bered, that I do not here inveigh against their pro- 
per use, but only against their abuse. This is an 
evil of some magnitude in Great Britain ; and it 
appears to me imperative upon the profession, to 
take a closer and more impartial view of the pro- 
perties and operation of mercury, particularly of 
calomel, than has yet been witnessed ; seeing, as we 
do, that scrophula, hydrencephalus, consumption, 
and indigestion, are fast increasing upon us. 
These are all diseases of debility, and the last, 
though not the most formidable, is perhaps now the 
most frequent. In its treatment, it has been too 
general to disregard altogether the important prin- 
ciple, that " the relief of irritation is the great ob- 
ject of medicine ;" and it appears evident, that in 
endeavouring to remove supposed disease of the 
liver, our violent and deleterious measures have 
greatly multiplied real disorder and weakness of 
the digestive canal. 



PREFACE 



THE SECOND EDITION 



I would take the opportunity presented by the 
publication of a second edition of this volume to 
say, that its contents are solely the result of personal 
observation and experience, and I therefore must 
hold myself responsible for the correctness of the 
opinions herein advanced. Many of these senti- 
ments are at variance with those widely received 
on the same subjects, and some of them lead 
directly to the adoption of a treatment the very re- 
verse of what is too commonly, perhaps I ought to 
say generally, followed ; but when our conclusions 
are drawn from close observation of the course of 
a disorder, and the operation of different remedial 
measures upon it, no difference from general senti- 
ments, however great, ought to deter an author 
from the statement of his opinions. On the con- 
trary, the greater this difference, on points involving 
practical consequences, the more desirable is it that 



Vlll PREFACE. 

the conclusions should be fully stated, and I have 
here therefore proceeded on this conviction. 

If it is lawful to judge from the effects of reme- 
dies on my own dyspeptic system, on that of a 
near relative who is always in my house, and on 
the constitutions of the many patients I have seen, 
I must infer that the principles on which indiges- 
tion is generally treated admit of great and mani- 
fest improvement. It appears to me that we may 
come to the same conclusion, in regard to the in- 
dications which regulate the treatment of chronic 
disease in general, and I think, notwithstanding the 
multitude of medical books now in being, that a 
Treatise describing at length the nature and correct 
principles of treatment of chronic disease in gene- 
ral^ is a work much wanted, and, from the greatly 
increased and increasing number of chronic mala- 
dies, capable of being made of more real service to 
the public, than any other single medical publica- 
tion that has been, or could be written. In the 
absence of such a book, the young medical practi- 
tioner cannot too sedulously yield himself to the 
study of the principles of management described in 
the fourth chapter of this volume, which will be 
found to be those of the greatest importance in all 
chronic disorders. 

Croyden, Surrey. 



CONTENTS, 



Preface «... iii 

CHAPTER I. 

Nature and symptoms of Indigestion . . 13 
Prominent evils in the Medical practice of the present day 1 3 
Origin of the terms nervous and bilious . . 15 
Frequency of liver conplaints questioned . . 16 
The acute sensibility, nervous connexions and superior im- 
portance of the stomach and intestines . 18 
Influence of the sympathetic nerves . . 19 
Inferior sensibility and importance of the liver . 20 
Extensive influence of the assimilating viscera over the other 

organs of the economy . . .23 
Principal causes of the prevailing idea respecting the uncom- 
mon frequency of bilious and liver complaints . 26 
Swelling and pain in the pit of the stomach and right side 28 
Mr Abernethy's treatment of such cases contrasted with the 

ordinary mode . . . .28 

Means of distinguishing affections of the liver from those of 

the digestive tube ... 30 
Symptoms indicating irritation of the mucous membrane of 

the stomach, duoi&num and colon . . 30 

Remarks upon the situation and affections of the duodenum 32 

The colon and its affections . . . 34 
Dr Curry's opinions . . . .39 
The nature and origin of discoloured stools, commonly 

called bilious . . . . 41 

Origin of bloody discharges by the mouth, &c. . 45 

of black vomit and bilious discharges . 50 

Superior value of Dr Jackson's works on fever . 51 
Opinions of Portal and Howship relative to the nature of 

black evacuations .... 53 



X CONTENTS. 

Erroneous opinions of Dr Ayre respecting the source of the 

blood discharged by vomiting . . .54 

Refutation of these opinions by Andral, Abernethy, &c. 56 

Dr Ayre's pathological opinions relative to hepatic influence 

in marasmus condemned . . . 57 

Dr Pemberton's views on marasmus . . 6 1 

Yeasty discharges, with a case by Dr Blackall . 63 

Dr Good, too fond of making the liver a vortex of disease 66 

Remarks of M. Andral, Jun., relative to the pathology of 

diarrhoea, dysentery and lientery . . 68 

The stomach and bowels the true seats of disorders popularly 

termed bilious . . . . 72 

Effects of mercurials . . . .72 

Mr Abernethy not one of those who consider the liver to be 

the root of all evil in diseases of the chylopoietic viscera 76 
The investigations of Broussais, Andral and other continental 
authorities, show that the liver is much less frequently 
effected than the English physicians generally suppose 80 

Dr Curry's erroneous opinion of his own case . 81 

Powerful influence of climate in modifying the operation of 

remedies . . . . .84 

Large doses of calomel prescribed in the Indies and some 

parts of the United States . . . 85 

Yellowness of the eyes not ne'eessarily connected with dis- 
ease of the liver . . * .88 
Intermittent pulse and fluttering at the pit of the stomach 94 
Increased mortality in Great Britain from apoplexy and palsy 97 

CHAPTER II. 

Varieties of Indigestion ... 98 

Situated in the stomach . . ' . .99 

■ small intestines . * . iqo 

biliary organs . . . iqi 

large intestines . . \q 



Diagnostic symptoms of the different forms of dyspepsia 104 

Character of the pulse . . . . 1 05 

Forms of dyspepsia which are most common and intractable 106 
The bowels- the seat of those internal disorders which prevail 
in autumn, as well as the source of gout, tic-douloureux, 

scrophula, &c. . , . # iq6 

States of the general system in dyspepsia . 108 



CONTENTS. . XI 



CHAPTER III. 



Causes of Indigestion . . . 110 

Sedentary living and mental anxiety the principal . 112 

Repletion . . . . 113 

CHAPTER IV. 

Treatment of Indigestion . • .116 

General principles . . . . Hf 

1. To restore healthy secretions . • H7 

2. To augment the strength . . 117 

3. To relieve irritation . . .117 
Debility a frequent source, of depraved secretions 119 
The relief of irritation a grand principle . 121 
Particular remedies . . . .123 

1. Medicine . . . . 123 

Mercury to be used with caution . .125 

Different effects from the same preparation given 

in large and in small doses . . 126 

Testimonials against salivation . .127 

The admirable effects produced by mercurials in 

some cases has led to its abuse . 131 

Effects of mercurials upon the nervous system 134 

Opinions of Drs Hamilton, Alley, &c. relative to the 

poisonous qualities of mercury . .135 

Permanency of its deleterious effects . 137 

The mercurial combinations most useful in dyspep- 
tic complaints . . .139 
Valuable qualities of rhubarb and ipecacuanha 139 

tartarized antimony . 144 

nitric acid . 145 

alkaline solution . 148 

Proper aperients for dyspeptics . . 158 

Nitro-muriatic acid bath . . 158 

Indigestion depending upon a contraction of the 

rectum . . . .158 

Treatment of local pain and uneasiness occurring 

in Indigestion . . . 1 60 

Treatment of the inflammatory or excited form of 

dyspepsia . . . .161 

2. Diet .... 162 



Xll CONTENTS. 

When this should consist of vegetable substances 163 

When of animal, with the best kinds . 163 

Nature of fish . . . 164 

Comparative digestibility of fluids and solids 164 

Most suitable drinks . . .165 

Opinion of malt liquor . . 168 

3. Regimen . . . .168 

Useful auxiliaries . . . 172 

CHAPTER V. 

Of tic douloureux, gout, and fulness of blood in the head, as 
dependent on indigestion . . .174 

APPENDIX. 

Notice of the "Dyspeptic's Monitor" . . 183 
Dr Abercrombie's treatise on diseases of the sto- 
mach, &c. . . . .192 
— Mr Halstead's "new method of curing dyspep- 
sia" ... 194 
Professor Hitchcock's " Dyspepsia forestalled and 
resisted" a a . 206 



TREATISE 



ON 



INDIGESTION 



CHAPTER I. 



ON THE NATURE AND SYMPTOMS OF INDIGESTION, AND 
WHAT ARE USUALLY CALLED, BILIOUS OR LIVER COM- 
PLAINTS. 

There appear to me to be two prominent errors 
in the medical practice of the present day : one, is 
the mistaking severe disorders of the stomach, and 
intestinal canal, for disease in the liver; the other, 
is the employment of large doses of mercury, for 
the cure of these supposed " liver complaints." 
The mischief that arises from these errors is incal- 
culable. They are wide spreading evils, whose 
destructive influence is unhappily felt by persons 
of every age, rank, and condition, and which call 
aloud for a remedy.* 

* The evils here adverted to, though exceedingly prevalent 
throughout the United States, are more especially so in those situ- 
ated towards the south and west, where they exert an almost 
universal influence over the practice of medicine. — Edit. 
C 



14 NATURE AND SYMPTOMS 

The term " liver complaint" is now in the mouth 
of every one ; and it is well known, that mercury 
in some form, generally the most injudicious, is the 
universal medicine for all kinds and degrees of dis- 
order in the digestive organs. A patient suffering 
from such disorder, which is usually denoted by 
oppression at the stomach after eating, want of ap- 
petite, weakness, depression of spirits, irregularity 
of the bowels, discoloured motions, &c, can at this 
time hardly consult his physician or apothecary, 
without being told he has a " liver complaint" and, 
as a necessary consequence, being soon loaded with 
calomel or blue pill. Indeed, it is a fact, of which 
I am convinced from ample experience, that even 
the slighter forms of derangement in the assimilat- 
ing viscera are often designated by the above 
fashionable term, and treated accordingly.* 

It is much to be regretted, that there is a fashion 
in medicine, as well as in the other affairs of life. 
A few years ago, the majority of ordinary com- 
plaints were said to be on the nerves : now, they 
all depend upon, and centre in the liver. On this 
subject, a modern writer has well observed, " the 
princess, afterwards Queen Anne, was subject to 
hypochondriacal attacks, which her physicians pro- 
nounced to be spleen, vapours, or hyp, and recom- 
mended Rawleigh's confection, and pearl cordial, 
for its cure ; this circumstance was sufficient to 
render the disease and remedy fashionable, and no 

* See the valuable little work of Dr Hall on the Mimoses. 



OF INDIGESTION. 15 

other complaint was ever heard of in the precincts 
of the court but that of the vapours. Some years 
afterwards, in consequence of Dr Whytt's publi- 
cation on ' Nervous Diseases,' a lady of fashion was 
pronounced to be nervous — the term became gene- 
ral, and the disease fashionable ; and spleen, vapours 
and hyp, were consigned to oblivion. The reign 
of nervous diseases, however, did not long con- 
tinue, for a popular work appeared on Biliary Con- 
cretions, and all the world became bilious."* It 
is an unhappy circumstance, that the world still 
continues in this state, and that both the disease 
and its remedy have taken so deep a root in the 
professional mind, that there is yet no appearance 
of a change to another ideal fashionable malady, 
whose favorite remedy, we might hope, w r ould be 
a medicine more like pearl cordial or Rawleigh's 
confection than calomel, and therefore more con- 
genial to the human constitution, and which, if it 
were not attended with any sensible benefit, would 
possess, at least, the advantage of being innocent. 

Those disorders, which are, in common language, 
called bilious and liver complaints, are denoted by 
some or all of the following symptoms, viz. a sense 
of distention and oppression after eating, with flat- 
ulent, acid eructations ; diarrhoea, or constipation 
and uneasiness of the bowels ; furred tongue ; im- 
paired appetite and strength ; discoloured motions, 
they being either green, dark-coloured, black, or 

* Paris's Pharmacologia, vol. i. 



1 6 NATURE AND SYMPTOMS 

much too light; nausea, headach, and bilious 
vomiting; palpitation of the heart, with or with- 
out occasional pain in that organ ; pain in the pit 
of the stomach and towards the right side ; sallow- 
ness of complexion ; and depression of the spirits : 
— and if the chief, or the whole of these symptoms 
are present, especially if in a severe degree, it is 
usually considered Efficient to justify the opinion, 
that a liver disease exists. But according to my 
experience, a very large majority of those mala- 
dies are not liver complaints, but properly disorders 
of the stomach, and intestinal canal ; and this fact 
will form the subject of consideration in the first 
part of this book. 

It is acknowledged, ttrat in every severe disor- 
der of these viscera, the liver participates, and its 
secretions are consequently vitiated ; but this is a 
secondary affection, and very different from the 
state in which that organ is usually considered to 
be found. They are not, as is erroneously ima- 
gined, primarily and chiefly liver diseases, in which 
there is, at least, incipient disorganization of that 
viscus, or a condition nearly approaching to it, 
which is the idea commonly intended to be con- 
veyed to patients, and generally received by them, 
from the use of the term liver complaint; but are 
functional derangements of the stomach and intes- 
tines, the liver being affected secondarily and sym- 
pathetically ; and so far from requiring large and 
repeated doses of mercury, for the restoration of 
its healthy functions, that they can be permanent- 



OF INDIGESTION. 17 

ly re-established only by the use of means directed 
to correct the original morbid affection. Among 
these means, we shall see that mercury is not 
always admissible, even in minute doses, and that 
in large ones it is invariably pernicious. 

So vast a sink of disease has the liver been 
thought of late, that it is considered by some men, 
of no small professional eminence, as amongst the 
greatest improvements of modern medicine, that 
the attention of the practitioner is duly awakened 
to the "remarkable sympathy" which it exerts in 
its functions with all the other viscera ! This sen- 
timent appears to me utterly inconsistent with our 
physiological knowledge, and with the light thrown 
on the pathology of abdominal disease by morbid 
anatomy : it seems invalidated by established facts. 
When we remember the dull sensibility of the liv- 
er, and the loose* connexion it has with the other 
viscera of the abdomen, and with those of the chest, 
by reason of the small number of its nerves, we 
are at a loss to conceive how this "remarkable 



* I wish the reader to bear in mind, that throughout this book, 
when contrasting the abdominalconnexions and general sympathies 
of the liver with those of the stomach and intestines, I speak rela- 
tively. It cannot be my desire to endeavour to show that the 
liver is really slightly connected with the other abdominal viscera 
and general system, but that this connexion is much inferior to 
that of the stomach and bowels. It is on this inferiority of con- 
nexion and sensation, that I found my opinions of its inferior im- 
portance to the well-being of the whole frame, which if I succeed 
in proving, is all I require to show that other language, and more 
lenient treatment, than is commonly employed, ought to be 
adopted. 



18 NATURE AND SYMPTOMS 

sympathy" can exist between them; and if our 
judgments are unbiassed by theory— unwarped by 
bile, surely we are naturally led to question it; but 
if it be transferred, as it ought to be, to the ali- 
mentary canal, we are so far from being unable 
to perceive the source of that intimate and impor- 
tant sympathy subsisting between this and every 
other organ, and indeed with the remotest parts of 
the body, that we are surprised it has so long es- 
caped due attention. For whilst the anatomist 
notes the comparative paucity of nerves distributed 
to the hepatic viscus, he is struck with the number 
and variety of them, almost innumerable, which 
ramify and subdivide upon the alimentary canal 
and mesentery, especially upon the upper part of 
the former. These, by their connexions with each 
other, with the nerves of the spinal marrow 
throughout, and with those of the chest and head, 
establish such an intimate intercourse of sensations 
and afFections between themselves, and every other 
part of the body, as readily explain the marked 
and powerful influence they exercise over the 
functions of every organ, even the most distant, 
and of both the external and internal surfaces. In 
these nervous connexions, and in the elevated sen- 
sibility arising from and dependent upon them, 
we at once recognise the foundation of the consti- 
tutional origin of local diseases, and the source of 
those wandering pains, and indescribable sensations 
as well as of that great nervous depression, and 
general disorder and debility, invariably accompany- 



OF INDIGESTION. 19 

ing an unhealthy state of these assimilating viscera. 
By reason of these extensive and diversified asso- 
ciations, the stomach and bowels become a centre 
of sympathies, and disorder, originating here, rapid- 
ly propagates itself to every other part. Thus we 
see the propriety and necessity of attending closely 
to the state of these internal viscera, in diseases of 
every class and degree, whether original or sym- 
pathetic. 

Though I do not consider the nerves as the ex- 
clusive instruments of sympathy, they are unques- 
tionably the chief sources of it ; and, therefore, it 
is a natural inquiry, where this "remarkable sym- 
pathy" clearly appears from disordered liver, and 
how does it arise, situated as this viscus is, so much 
without the nervous connexions established be- 
tween the remaining assimilating viscera, and all 
other parts of the body, by the important system 
of the great sympathetics, and the par vagum? 
These sympathetic nerves are the principal links 
which unite the internal nutritive functions, to 
those which keep up the relation of the animal 
with external objects; and it is by this bond of 
union that the derangement of their important func- 
tions, whether by acute or chronic disease, is neces- 
sarily attended with proportionate changes in all 
the acts of the animal economy, in the same man- 
ner as the defects of one wheel interrupt or dis- 
turb the mechanism of a whole machine. But, 
as was observed above, so imperfect are the sensi- 
bilities of the liver, that though acute inflammation 



20 NATURE AND SYMPTOMS 

of any portion of the alimentary canal is invariably 
marked by the acutest suffering, and the most 
alarming symptoms, which, if not checked, 
speedily terminate fatally, inflammation of the liver 
will be making destructive progress when the pa- 
tient slightly complains only of a flux, — frequent 
inclination to stool, — gripings and watery motions ; 
the heat of the surface being but little increased, 
and the pulse neither hard nor quick ; and thus he- 
patitis generally appears, even under the burning 
sun of the east. Morgagni mentions several in- 
stances of inflammation of the liver, marked by no 
peculiar symptoms, an occurrence with which our 
naval and military surgeons, who have served long 
in tropical climates, are very familiar.* In the 

* Dr Archibald Robertson, in his Medical Topography of New- 
Orleans, in describing the frightful march of dysentery, which 
6i knew neither pause nor hindrance, but, like the fabled vulture of 
ancient mythology, pursued its cruel task from day to day" amongst 
the British troops before that place, observes : — " Oftener the com- 
plaint would make its attack with the common introductory symp- 
toms, and no pain in the right hypochondrium was felt through- 
out the disease, either on inspiration, or strong pressure under the 
false ribs. In whatever garb of disguise it made its appearance, 
disease of the liver (as I have before stated,) and, consequently, 
a vitiated state of its secretions, were undoubtedly the primary 
cause of the mischief. Dissection of the fatal cases showed 
structural derangement, — a soft friable condition, and generally 
suppuration of that gland. I have often found two separate ab- 
scesses in the parenchyma of its large lobe, the one generally less 
deep-seated than the other, and containing, in some instances, a 
quart of pus, similar in colour and consistence to what is usually 
found in psoas abscesses. How such extensive disorganization 
and formation of matter could take place, without any preceding 
palpable indication of local mischief is to me still a mystery : 



OF INDIGESTION. 21 

ordinary chronic affections, also, of this viscus, oc- 
curring in this country, so great is its insensibility, 
so indistinctly do the other viscera of the abdo- 
men, and the general system sympathize with it, 
that extensive organic mischief has often been de- 
tected in it by the knife of the anatomist after 
death, when the patient during life was uncon- 



But such was the fact." In noticing the appearances on opening 
the abdomen of a naval officer, who fell a martyr to dysentery off 
New Orleans, he says,—" After the liver had been removed, and 
laid out for minute inspection, I found an abscess of such extent 
and so lined in its inner surface with a thick, fretted, and irregular 
exudation of coagulable lymph, that it resembled a familiar and 
homely object, viz. a large winter glove, lined with worsted ! On 
accurate examination, a second abscess was found, lower down 
in the large lobe, containing a pint of pus." 

" This officer had never, at any period of the disease, felt any 
■pain in his side : From his general intelligence, and from the 
accurate descriptions he gave me daily of his minutest sensations, 
I am convinced he would have mentioned that pain, had it exist- 
ed, even to the extent of a 'sensus molestise.' Besides, he 
was one of the last men in the world that one would have suspect- 
ed of hepatic affection, being florid in complexion; and having 
previously enjoyed the best health all his life." 

" Instructed by this insidious case, I had my eye to the liver 
ever afterwards; but pain of side, or pain on pressure under the 
ribs, was by no means often felt, though dissection after death 
brought to light hepatic disorganization, equally extensive as in 
the above case." — Dr Johnson on Tropical Climates, page 438. 

Though I cannot agree with Dr Robertson, that this hepatic 
disease should be considered as the chief and primary cause of 
dysentery, it being regarded by me as one only, and most certain- 
ly not the principal, in a series of morbid causes ; yet these ex- 
tracts tend irresistibly to convince us of the truth of what I here 
advance, and which it is material for the profession and the public 
to reflect upon, — the natural and conspicuous insensibility of the 
liver, and the inferior importance of its functions. 



£2 NATURE AND SYMPTOMS 

scious of any thing wrong in that region. These 
persons, when alive, had shown no yellowness or 
sallowness of complexion, had complained of no 
pain in the right side, or shoulder, nor suffered 
under any perceptible weakness, or any other symp- 
tom which could lead their friends or physician to 
suppose, that so large a viscus w 7 as actually in a 
state of irremediable disease. Are not these facts 
irreconcileable with the hypothesis, of an impor- 
tant and remarkable sympathy existing between 
hepatic derangements, and all the other acts of the 
animal economy ? Do they not, on the contrary, 
forcibly convince us how comparatively imperfect 
the relation of the liver is, how inferior its sympa- 
thy, with other parts ; proving most satisfactorily 
the error and folly of calling the prevailing disor- 
ders of the digestive organs, bilious complaints ? 
And when we reflect upon the extensive nervous 
influence, the exalted sensibilities, and the great 
importance of the functions of the stomach and 
bowels, do not the probability and rationality of 
considering these affections as centering here, and 
not in the liver, become apparent ? 

The fact of positive disease frequently taking 
possession of the liver, without the constitution, or 
any single viscus sympathizing with it, and, there- 
fore, without its being discovered during the life of 
the patient, cannot be denied. In order to over- 
come the powerful argument thence derived, 
against the supposition of so " remarkable a sym- 
pathy" being exerted by this viscus, in its functions \ 



OF INDIGESTION. 23 

with all the remaining viscera, will it be asserted, 
that it is not the organic injury, but the simple de- 
rangement of function in the liver, that is attend- 
ed by effects so extensive and pernicious ? This 
follows of course : But it is, at least unreasonable, 
and contrary to what takes place in any other 
organ ; having for its support, merely the disco- 
loured appearance of the alvine discharges, and the 
power of mercury in restoring them to their natu- 
ral colour, w 7 hich we shall presently see is a weak 
prop. Those w T ho maintain this opinion have the 
cause of an improbable anomaly to explain, for we 
meet with nothing similar in the lungs, the head, 
the digestive tube, or elsew 7 here. Here the favor- 
able prognosis of the physician is in proportion to 
the freedom of the affected viscus from structural 
disease, and the degree in which the remaining vis- 
cera sympathize with it, and in which the general 
habit emaciates and sinks, is also generally in the 
same proportion. This accords with all we know 
respecting the laws of organic life ; and before it 
can be admitted, that these laws are reversed in 
favour of hepatic derangements, we must assuredly 
possess some clearer and better reasons for it than 
have hitherto been attempted. 

The stomach, and first intestines, unquestionably 
perform the most important offices in the frame, 
and are the grand sympathizers with all the local 
and constitutional derangements of the system, the 
cause of which has been pointed out as arising 
chiefly from the enlarged and varied communica- 



24 NATURE AND SYMPTOMS 

tions of those nervous apparatus, known by the 
name of the great sympathetics, and par vagum. 
These assimilating viscera carry with them in their 
action all the other organs of the economy ; "they 
summon to their aid the whole system of the vital 
powers ; and this sort of derivation is the more con- 
spicuous as the organization is more delicate, the 
sensibility more lively, the susceptibility greater." 
In short, it may be truly remarked, that they are 
the great arbiters of health and disease, of life and 
death. Yet, in the modern fashionable system of 
the pathology and treatment of abdominal disease, 
these are considered parts of far inferior conse- 
quence to the liver ; this is regarded as the fruitful 
"fons malorum" and thus we retrograde in our 
knowledge of diseases, and in our acquaintance 
with the means of cure. 

In the adult,* the alimentary tube is at least six 
times the length of the body: so delicate is its 
organization, so important its functions, that, as we 
have seen, it possesses a distinct system of nerves, 
remarkable for their acute sensibility,! and for the 
fineness, as well as the number, and the connexions 
of their filaments. It is the grand medium of 
sympathy ; and there is an immediate connexion 

* In children it is a great deal more extensive than even this, 
the extent of surface which it unfolds, being always proportionate 
to the assimilating exigencies of the constitution. Since the growth 
of the body is most rapid in the earlier periods of life, this impor- 
tant tube is therefore then proportionally longer. 

t It is true that this sensibility is siti generis. 



OF INDIGESTION. 25 

between it and the centre of all nervous influence, 
the brain, for there is an union in the stomach of 
the cerebral and sympathetic nerves : in it, the food 
we take is converted into a homogeneous nutritive 
fluid, which now nearly resembles, and is soon ac- 
tually to become blood, the substance that gives 
life and energy to every part. This canal is the 
distinguishing characteristic that separates the ani- 
mal from the vegetable creation, and is therefore 
essential to every animal, from the zoophyte, eter- 
nally fixed in his rocky habitation, up to man, 
whose restless activity carries him to the very ends 
of the earth. It is the part to which the proper- 
ties of life seem to adhere with the greatest tena- 
city, for whatever is the kind of death the animal 
dies, this is the last organ in which the traces of 
life may be discovered. Moreover, it is the most 
irritable part of the human body; and such are its 
connexions and sympathies, that the morbid phe- 
nomena, resulting from irritation of its internal 
membrane, are infinitely more numerous and dis- 
tressing than all the rest of the catalogue of human 
diseases collectively. It may be safely asserted, 
that seven-eighths of human afflictions originate in 
this cause. No bounds can be placed to the various 
maladies it stimulates, and to which it gives rise. 
At one time it will produce all the phenomena of 
typhus fever, of the most malignant grade, and the 
patient will be as completely delirious as in phre- 
nitis itself: at another, the interruption to digestion, 



26 NATURE AND SYMPTOMS 

conjoined with the sympathetic disorder of various 
other functions of the system, resulting from sim- 
ple irritation of this extended surface, will termi- 
nate in actual dissolution, no traces of disease being 
discoverable in it, or in any other part after death. 
Then, surely, the man who can compare the im- 
portance of the hepatic functions with those of 
this tube,— who can regard the disorders of the 
former as those which should engage our chief at- 
tention in abdominal derangements, and in the 
diversified, local, and general maladies, to which 
the human body is subject, takes a lengthened stride 
backwards in physiological and pathological science, 
which every benevolent mind must regret, on ac- 
count of its consequences, and in which no one 
will follow him who attains to correct views, and 
to a successful practice in medicine. 

There are several circumstances which have 
concurred to render hepatic disorders and diseases, 
and their remedy, calomel, fashionable in Great 
Britain. The five following have probably had 
the greatest weight, and we shall, therefore, con- 
fine our attention principally to them. 

They are, — 1st. A fulness, and tenderness on 
pressure, and pain, being often present at the pit of 
the stomach, extending a little to the right side. 

2d. The alvine discharges being almost always 
discoloured in bowel complaints, and not unfre- 
quently green or black, like pitch, from which 
they have been called bilious; and the power of 



OF INDIGESTION. 27 



small doses of mercury, in correcting this appear- 
ance.* 

3d. Organic disease being sometimes found in 
the liver after death, in cases of intestinal, and 
other disorders, when no traces of such mischief 
are detected in any other viscus. 

4th. A great number of our countrymen annu- 
ally return from the East and West Indies with 
biliary and intestinal disorders, arising from their 
residence within the tropics, where the liver is 
the organ the most obnoxious to disease, and 
where calomel is the sovereign remedy for all 
bodily ills : these, on their return to England, are 
ready to pronounce the maladies of their friends to 
be liver complaints, and cannot, of course, conceive 
any other medicine equal to calomel. 

5th. The sensible influence which the opinions 
and practice of professional men from India have 

* In almost every instance where from a diseased action in 
some part of the intestinal canal, more particularly in the colon 
and lower portion, the ordinary secretions of its surface become 
changed and the appearance of the stools correspondingly altered, 
a liver affection is supposed to be at the bottom of the case. Should 
the stools be darker than ordinary, or green, the bile is pronounced 
vitiated, and nothing will serve to correct it but a course of mer- 
cury. If on the contrary the colour appears lighter than usual, 
the bilious secretion is deficient, the liver torpid or its ducts ob- 
structed. Under all these circumstances the real seat of the disease 
is generally overlooked, and an erroneous practice adopted. The 
true causes of the diversified appearances produced by the most 
frequent disorders of the first passages will be found very happily 
explained in a subsequent page of this treatise. — Edit. 



28 NATURE AND SYMPTOMS 

had and still continue to have, over medical prac- 
tice at home.* 

1st. The fulness and tenderness here referred 
to must not be confounded with the enlarged and 
indurated state of the liver, occasionally to be felt 
by manual examination. This is generally too 
sure an indication of organic injury in that viscus, 
while the former, for the most part, affords us no 
grounds for such a suspicion.! 

This fulness and soreness at the pit of the 

* The prejudices which prevail in our southern and western 
states exert no less influence over the practice of this country, 
than those of the physicians from India over that of England. — 
Edit. 

t Mr Abernethy (at page 88 of his Observations on the Consti- 
tutional Treatment of local Diseases) has related the case of a 
young lady, in whose hepatic region an incipient enlargement 
and hardness of this kind was felt externally. While reading it, 
I could not help contrasting the gentle means this gentleman used 
with perfect success for the cure of this affection, consisting of 
" mild mercurials and aperients," with the active stimulant mea- 
sures too commonly resorted to in similar instances, where calomel 
in large and oft-repeated doses is forced upon the unhappy patient. 
He says, " I found, upon inquiry, that the chief seat of her pains 
was in the posterior edge of the liver. Indeed, that viscus was en- 
larged, so as to be felt in the epigastric region, and was so tender 
as to cause much pain on being compressed, at any part along 
the cartilages of the ribs. Her tongue was furred; her appetite 
deficient; digestion bad; bowels costive; and stools black, or else 
untinged with bile. I had no hesitation in advising that attention 
should be chiefly directed to rectify the disorder of the chylo- 
poietic viscera. Mild mercurials and aperients were given, by 
which, with other means, she got materially better in health, and 
was able to walk about as well as ever. The gentleman, who at- 
tended this patient, met me accidentally two months afterwards, 
and informed me that she was quite well." 



OF INDIGESTION. 29 

stomach, and in the right side, I believe usually to 
depend upon irritation and debility of the internal 
surface of the stomach, duodenum, or colon ; and I 
think that the situation, and acute sensibility of 
these parts, — the frequently rapid development of 
the symptoms, — the character of the swelling,— 
the effects of remedies, — the insensibility of the 
liver, and the appearances, on dissection, of fatal 
cases, sufficiently prove the correctness of this idea. 
At first view, it is evident that Ave must often 
be liable to mistake the nature and seat of the 
swelling and pain we are considering, if great at- 
tention be not paid to the case, since the stomach 
and duodenum, as well as the colon, are situated 
in the immediate region of the affection, close upon 
the biliary organs. The ensiform cartilage, or 
what in common language is called the end of the 
breast-bone, will be found to present commonly to 
the middle of the stomach, and the lower orifice 
of this organ, when in its natural state, is opposite 
to the fossa umbilicalis of the liver: — The duode- 
num, or first intestine, on quitting the stomach, 
goes in a direction downward ; then it passes up- 
ward till it touches the gall-bladder; then making 
a sudden turn, it descends directly near to the right 
kidney, and is involved in the lamina of the mesoco- 
lon ; it then takes a sweep towards the right side, ob- 
liquely across the spine: — the colon ascends on the 
right side of the small intestines, before the kidney; 
passes across the upper part of the belly, under the 
margin of the liver (in contact with the gall-blad- 

E 



30 NATURE AND SYMPTOMS 

der), and before or under the stomach. Such 
being the situation of these viscera, and of the liver, 
we cannot be surprised if their derangements are 
often confounded, and that swelling and tenderness, 
existing either in the stomach, or duodenum, or 
colon, should, for want of strict examination, and 
from the superior attention paid of late to the liver, 
be ascribed to disorder or disease of this part. 

Tenderness and swelling on the upper and fore 
part of the abdomen, is frequent in disorders of 
the digestive tube, but they are in general different 
from those arising from enlarged liver, both in seat 
and character ; the fulness not being situated so 
much towards the right, or so low as the latter, 
and being not a hard, but a puffy, elastic swelling. 
The tenderness also differs in its seat, from that 
produced by hepatic affection, in the same way as 
the enlargement, and it is not, like the latter, felt 
only on pressure of the hand, but is almost always 
present, more or less, until removed by the appli- 
cation of remedies, and is sometimes very trouble- 
some when no pressure whatever exists on the 
part. The fulness consequent upon chronic he- 
patitis is very generally quite on the right side, 
and felt lower than the epigastric region ; but when 
it arises from irritation of the mucous membrane 
of the stomach, it is found mostly at the very end 
of the breast-bone:— w r hen it is the consequence of 
a similar state of the duodenum, a little to the 
right, and somewhat lower than the termination of 
this bone. When it is still lower, and seemingly 



OF INDIGESTION. 31 

across the upper part of the belly, the colon is 
generally its seat.* 

These symptoms often supervene in two or three 
weeks, or even a shorter time, after the patient is 
first conscious of indigestion, which is extremely 
unfavourable to the supposition of existing liver 
disease, as organic derangement takes a much 
longer time to develope itself in chronic disorders. 
From the acute sensibility of the alimentary canal, 
we are not at a loss to account for the rapid 
development of these phenomena, while the faint 
sensibility of the liver becomes an additional 
reason for our considering pain and swelling, in its 
texture, to be rare when compared with a similar 
condition of the digestive tube. The different 
effects which follow local blood-letting in the two 
complaints, likewise point out a real difference in 
their nature. In this puffiness which I consider 
symptomatic of disorder in the alimentary canal, 
the application of leeches is indicated, and is almost 
immediately followed by striking, permanent 
benefit: in chronic disease of the liver, the local 
abstraction of blood is rarely indicated, and, w r hen 
resorted to, is attended with very little and transi- 
tory relief. Besides these well-marked distinctions 

* The special attention of the reader is requested to the de- 
scriptions, contained in the preceding and following paragraphs, 
of the relative situation of the parts in the abdomen, most com- 
monly the seats of disease. A thorough acquaintance with this 
subject is of the first importance towards arriving at a correct 
diagnosis.— Edit. 



32 NATURE AND SYMPTOMS 

between the two maladies, it will be found, if I 
mistake not, that the pain changes its place a little, 
and the patient gains some relief, on the expulsion 
of wind, in this affection of the stomach or bowels, 
which change and relief do not occur in diseased 
liver.* 

The duodenum, or first intestine, is fixed by a 
rather loose cellular tissue to the posterior side of 
the abdomen, and dissection has proved, that it is 
susceptible of such dilatation, as occasionally to 
equal even the stomach in size. The existence of 
pain in this part may frequently be detected by its 
being felt under the seventh or eighth rib, passing 
deep, seeming to be in the seat of the gall-bladder, 
and stretching towards the right hypochondrium, 
and to the kidney, and again appearing as if on the 
loins. From the course of the duodenum, we 
should expect pain in it to take this direction, and 
we readily perceive how liable it is, in our day, to 
be confounded with that arising from hepatic 
affection. Dr James Hamilton, Jun. remarks, that 
when along with the usual symptoms, there is a 
milky white appearance of the urine, as if it were 
mixed with chalk, he never has any doubt on the 
subject of its being a disorder of the first intestine, 
because he has invariably found the duodenum 
affected under such circumstances, and he never 
observed the same appearance of the urine in 

* Ferriar's Medical Histories, vol. ii, page 28. 



OF INDIGESTION. 33 

diseased liver.* I am sorry that I have not been 
able to ascertain what importance is to be attached 
to this symptom. If future observation should 
prove it to be generally present in the disorders 
of the first intestine, while it is as often absent in 
cases of disorganized liver, of course it will materi- 
ally assist us in forming a correct diagnosis in these 
diseases. It is nearly certain, that in disease of 
the biliary organs, the urine seldom fails constantly 
to deposit a pink sediment, which kind of deposition 
very rarely appears, for any length of time, in 
disorder of the digestive canal. 

The duodenum is more glandular, and more 
vascular than any other part of the small intestines ; 
it is the part which receives the biliary and pan- 
creatic fluids, where the peristaltic motion is begun 
in the natural action of the bowels, and in which 
a kind of second stage of digestion takes place; 
and it is to be regretted that its disorders do not 
gain greater attention among us, as it is more than 
probable that they constitute some of the most 
painful and severe within the abdomen, and form 
no mean proportion of those maladies commonly 
treated as liver complaints, Hoffman, Sylvius^ 
and a few others, have treated of them in their 
works, in an instructive way ; and Mr John Bell 
correctly observes, that it has been the opinion of 
the most respectable old physicians, those whose 
knowledge of diseases has been drawn from an 

* Observations on the use and abuse of Mercury, page 110. 



34 « NATURE AND SYMPTOMS 

acquaintance with anatomy, from the frequent in- 
spection of dead bodies, and the observation of the 
symptoms during life, that the study of the diseases, 
connected with the duodenum, is the most impor- 
tant which can occupy the attention of the medi- 
cal inquirer.* 

The intestine colon seems especially liable to 
excessive irritation and disease, and that tenderness 
and swelling in the right side is often owing to 
such a condition of this part, I am persuaded from 
observation, and the fact is corroborated by the 
testimony of respectable writers. In the records 
of dissections of protracted and fatal cases of 
abdominal affection, to be found in different medical 
works, the colon is noted as having presented, in 
the majority of instances, particular marks of organic 
lesion. This is observable in the writings of Mr 
Abernethy, M. Louis, M. Broussais and Dr Black- 
all. Out of fifty-three cases of disease in the 
alimentary canal examined by M. Andral, Jun., 
twenty-eight presented remarkable disorganization 
only in the caecum and colon, and the greater part 
of the remaining number shewed an analogous state 
of the lower portion of the ileum, immediately 
joining the colon. In five out of six fatal cases of 
abdominal disease alluded to by Mr Howship, the 
disorganization was almost confined to this part of 
the canal. 

The following case, for which I am obliged to 

* Bell's Anatomy, vol. iv, page 70. 1804. 



OF INDIGESTION. 35 

Mr Howship, strikingly exemplifies the mistakes 
sometimes made in practice, in considering an 
affection of this bowel as disease of the liver ; and 
it is hoped that it will prove an useful illustration 
of the correctness of the opinions above delivered 
on this point. 

" The subject of this case was a lady, whose 
complaints had, by various practitioners, been at- 
tributed to disease in the liver; upon which pre- 
sumption she had, in the early part of her illness, 
been repeatedly subjected to the influence of mer- 
cury, without benefit. Of several who had seen 
and attended her, Dr Hooper was the only physi- 
cian who could never be persuaded to believe «her 
complaints hepatic, notwithstanding constant local 
uneasiness, frequently severe pain, and a degree of 
tumour below the cartilages of the ribs on the 
right side, with occasional pain at the shoulders. 
The action of the bowels was irregular ; sometimes 
there were twenty-four stools in as many hours ; 
at others, strong purgatives were required to be 
frequently given for days together, without effect." 

A variety of medicines were given, but in vain, 
and she died in February 1820. 

" On examination, in presence of Dr Hooper, 
1 found a thickened, discoloured, soft and elastic 
tumour, lying across the upper part of the abdo- 
men, a circumscribed portion of which tumour had 
visibly raised the external parietes, previous to 
their being laid aside. From the right extremity 



36 NATURE AND SYMPTOMS 

of this tumour several strong adhesions passed off 
to the adjacent surface of the parietes ; from its 
anterior part also, several short thick cords, the 
result of effusion, were firmly attached to the 
peritoneum, just within the scrobiculus cordis. 
The tumour itself turned out to be the stomach 
and transverse arch of the colon, closely and com- 
pletely adherent to each other ; the former viscus 
much discoloured, the latter much diseased, so 
altered in texture, and so much thickened, as to 
have entirely lost its natural characters." 

" The adhesions just mentioned were exceedingly 
strong, and all proceeded from the colon, which 
had evidently been the seat of the primary inflam- 
mation. The bands attached to the scrobiculus 
cordis clearly explained the distressing sense of 
gnawing, or burning, or glowing heat, with the 
occasional sense of pulling, or drawing at that part, 
from which she was never altogether free." 

At the latter period of her illness, the patient 
had dropsy, and Mr Howship adds, "The ascites 
proved to have been merely the consequence of 
the derangement in the function of absorption, re- 
sulting from the first inflammation ; for the liver 
was healthy in structure, although its peritoneal 
covering was somewhat thickened."* 

Hard drinkers are thought to be particularly 
obnoxious to disease of the liver, which is unques- 

* Howship on Diseases of the Lower Intestines, page 80. — 
3d edition. 



OF INDIGESTION. 37 

tionably true ; but now that the diseases of the 
intestine colon are considered, I ought not to pass 
over unnoticed the fact, that in many such instances 
the hepatic viscus has been found after death quite 
healthy in its structure, while the only or chief 
disease has been in the colon. Mr Howship, at 
pages 123 and 125 of the work just referred to, 
has noticed two cases of this description, and Dr 
Blackall, in his work on dropsy, mentions others. 
Mr Howship's first case (page 103) was that of a 
gentleman, who, after many years of hard drinking, 
died from a blood-vessel in the lungs bursting into 
the cavity of the chest; "the liver, stomach, and 
bowels, were apparently healthy, except the head 
of the colon which felt thickened. I therefore 
dissected this part out, secured its vessels, and the 
same evening injected it. In this operation, scarce- 
ly any resistance was felt from the arteries ; and, 
on cutting open the bowels, I found this was owing 
to a broad band of ulceration, by which the villous 
membrane surrounding the head of the colon and 
cavity of the caecum was destroyed, the vessels 
upon the ulcerated surface allowing the injection 
to flow freely into the gut." 

With regard to positive pain at the pit of the 
stomach, and in the sides, I think it is so common, 
that few cases of derangement of the digestive 
organs occur without some degree of it, and there- 
fore it is not an indication of disease, or disorder 
in the liver. Dr Marshall Hall is of the same 
opinion. "Sometimes," he observes, page 75, 

F 



38 NATURE AND SYMPTOMS 

" there is extreme pain extending across the false 
ribs, leading to the suspicion of inflammation of 
the pleura, or, together with the affection of the 
complexion, it leads to the suspicion of inflamma- 
tion or disease of the liver/' — "It is distinguished 
by being liable to recede and to recur, by varying its 
situation, frequently by being unattended by 
tenderness on pressure, when the examination is 
made with proper care." This author is fully 
sensible how often pain in the sides leads to a sup- 
position of a "liver complaint:" in referring to the 
means of distinguishing those affections of the di- 
gestive organs, which are attended by a sallowness 
of complexion, and occasional pain in the side, and 
which are therefore often confounded in practice 
with disease of the liver, he remarks: "By these 
means, the list of chronic diseases of the liver would 
be considerably curtailed, for I could recall, at 
this moment, numerous instances of this error in 
diagnosis."* 

I have known several patients, in whom, together 
with the usual dyspeptic feelings, there was swell- 
ing and frequent darting pains in the epigastric 
region, and sides, who have been under the com- 
mon course of treatment for a "liver complaint" 
for several weeks, or months, without deriving 
benefit, but rather growing worse ; and who have 
had this pain almost directly removed, the enlarge- 

* Essay on the Mimoses (2d edition), page 144. See also the 
Cases at page 76 of the same work. 



OF INDIGESTION. 39 

ment also gradually disappearing, under the use 
of means directed to restore the digestive tube to 
a healthy state. In some cases of this description, 
there has existed so great a degree of tumefaction, 
and occasional pain, in the side, as would have led 
me, at first view, if I were not aware how fallacious 
these symptoms are, to pronounce them as certain 
indications of disease in the liver. When, how- 
ever, the other appearances denoting disorganization 
were absent, it has been my practice to reject such 
an opinion, and the effects of remedies have inva- 
riably proved its propriety. 

The late Dr James Curry (de mortuis nil nisi 
verum), whose book on biliary concretions, together 
with his mode of practice, operated greatly in 
making diseased liver, and its supposed remedy, 
calomel, so very fashionable and fatal, was so 
wedded to his notions on this subject, that in his 
patients, invariably, the liver was considered the 
real source of all their ailments; and if, when 
labouring under stomachic irritation and disorder, 
they complained of pain in the left side, in the 
region of the stomach, he would endeavour to per- 
suade them they were mistaken, and that it certainly 
was in the right ! If he could not bring them 
over to this belief, it was his custom to say — Ah, 
I shall bring it there then ! What value can be 
attached to the opinions, or what good could attend 
the practice of a man whose judgment was so 
amazingly perverted ? That this unfortunate phy- 
sician did often bring the pain to the right side 



40 NATURE AND SYMPTOMS 

there is no question, for he took a sure and speedy 
method of doing it, by administering his panacea 
(calomel), in large, oft-repeated doses, which, by be- 
ing excessively stimulating, and debilitating the se- 
creting vessels of the liver, and of all the other diges- 
tive organs, provoked disorder, and paved the way for 
a rapid supervention of disease. It is well known, 
that Dr Curry was in the habit of salivating peo- 
ple twice and even thrice during a single attendance, 
and it is to be feared, that the patients he has left 
behind, with broken, ruined health, " the remnant 
of their former selves," from the excessive use of 
calomel, are very numerous. The professional 
man, who allows his judgment to be so far per- 
verted by a favorite hypothesis, or notion, as to lead 
him, without scruple or care, to institute measures 
that are inimical and poisonous to the constitutions 
of his patients, may be truly called unfortunate, 
and his errors ought to be pointed out, that the 
public may be sensible of the danger of such 
means, and young practitioners also put upon 
their guard.* 

* I should not allude in this way to Dr Curry's opinions and 
practice, if it were not, in my opinion, necessary to bear the most 
pointed testimony against them. 

[Prototypes of Dr Curry are by no means uncommon in Ame- 
rica, and the number cannot be expected to diminish whilst the 
pathology of abdominal diseases remains in its present obscurity, 
and the prevailing prejudices in favour of hepatic predominance, 
and the indispensableness of mercury continue. Nothing but the 
establishment of the most positive data can arrest the progress of 
vague speculation, and free the judgment from perversion. — 
Edit'] 



OF INDIGESTION. 41 

2d. When the stomach and other digestive 
organs are weakened, it is certain that they are 
often unable to exert that power over the matters 
they contain, which in a state of perfect health 
prevents their acting chemically on each other, 
and occasioning decompositions and forming new 
combinations. This power, which the healthy 
stomach exercises over its contents, was appropri- 
ately called by Dr Fordyce, its governing power. 
Under disorder, when this governing power is lost 
or impaired, an acid is generated in the stomach 
and bowels, which decomposes the bile and pro- 
duces a green precipitate, and green stools are the 
consequence ; in other instances, the acid combines 
with the soda of the bile, and there is a thick, 
viscid, bitter precipitate, and the stools look like 
pitch. In some diseases, a green bile is brought 
up by vomiting. It is common to call such dis- 
charges as these bilious, and to refer their unnatu- 
ral appearance to a morbid action in the liver ; but 
the fact is, that the bile itself, in such cases, under- 
goes a chemical change in the stomach and intes- 
tines, in consequence of the energies of these or- 
gans being impaired by disorder, and the idea of 
these discoloured evacuations being owing to an 
unhealthy secretion of bile, receives therefore little 
countenance from their existence. In some in- 
stances they appear to depend purely upon this 
decomposition of healthy bile ; in others, upon that 
change united with diseased secretions from the 
alimentary canal itself: this last state is the most 



42 NATURE AND SYMPTOMS 

common, and is almost always present when the 
stools are very copious and fetid. That bile does 
undergo this decomposition, is proved by some 
circumstances which are observed to take place 
out of the body. It is known, for instance, that 
the faeces of infants, although yellow when voided, 
frequently become green after some time ; and the 
urine of a jaundiced patient, which is of a deep 
yellow when voided, becomes after a few hours 
green. It is not easy to account for this change 
of colour, but by supposing that an acid is gener- 
ated by the reaction of the elements of which the 
bile consists. Besides, we are aware that the in- 
testinal juice in a healthy state has a brackish taste, 
and turns turnsol paper of a deep red, shewing that 
it possesses acid properties ; it is more than proba- 
ble then, that under disorder, this acidity is much 
increased ; and that it should, in that condition, 
from its operation on the biliary and pancreatic 
fluids, give rise to green or black, viscid discharges, 
is no more than we might anticipate. 

That the black, pitchy, or yeasty, and fetid na- 
ture of the motions, are owing much more to an un- 
healthy condition of the mucous membrane of the 
bowels, than to a wrong action of the liver, is ren- 
dered more than probable by the large quantity of 
these matters often voided under disorder, — by 
the mucous and bloody fluids with which they 
are frequently mixed, evidently vitiated secretions 
from the intestines,— and by the organic lesions 
and marks of inflammation, not seldom found after 



OF INDIGESTION. 43 

death, in the large or small intestines in these cases, 
when the liver shews no appearances of disease, or 
excessive disorder. 

It is not likely, that the immense quantity of 
discoloured, offensive matter, sometimes discharged 
under severe disorder of the assimilative viscera, is 
poured forth entirely or chiefly from the liver, be- 
cause its secerning vessels bear no proportion in 
point of number, activity, or importance to those 
opening upon the vast line of bowel contained in 
the abdomen. Patients sometimes void, in the 
course of twenty-four hours, many quarts, and some 
even gallons, of various coloured liquids. Morgag- 
ni has cited the example of a woman, who, in one 
day only, passed, per anum, forty pints of a limpid 
fluid. Does it consist with our knowledge of 
physiology, to suppose that this is derived princi- 
pally from any other part than the mucous coat 
of the bowels, which only, from being of great ex- 
tent, seems fully adequate to such prodigious eva- 
cuations? Highly stimulating agents, such as 
large doses of calomel, excessive eating and drink- 
ing, and other similar practices, act directly on the 
mucous coat of the alimentary canal; they irritate 
and disorder it, the first effect of which is to occa- 
sion an augmented flow of blood into it, and its 
natural secretions become, in consequence, often 
increased, and almost invariably faulty. Some- 
times diarrhoea follows, and proves a salutary crisis 
to the existing irritation. The quantity of liquid 



44 NATURE AND SYMPTOMS 

occasionally exhaled by this coat under such cir- 
cumstances is astonishingly great.* 

The slimy mucus, frequently found mixed with 
the faeces of persons labouring under aggravated 
disorder of the digestive organs, is certainly indi- 
cative of a highly disordered state of the functions 
of the bowels. The quantity of this is sometimes 
excessive, and now and then appears like a purulent 
secretion. In adults, it is generally considered an 
indication of long standing disorder in the bowels.f 
It would appear, that there are not many cases of 
severe bilious disorder, where this slime is not re- 
markable, and we are assured it cannot come from 
the liver. It is particularly frequent in children, 
whose greater susceptibility and irritability render 
them very subject to bowel complaints : at which 
we cannot be surprised, when we recollect the 
close connexion subsisting between the alimen- 
tary tube, and every other part of the body, by its 
nerves and blood-vessels. In this association, we 
perceive the reason why painful dentition, indi- 
gestible food, or cold followed by fever, invariably 
produces disordered bowels, and unnatural stools. 
Indeed, let irritation of the nervous system be exci- 
ted from whatever cause, it is commonly followed 

* It is probable, that the quantity of healthy intestinal juice, 
formed in twenty-four hours, amounts to eight pints. This was 
Baron Haller's calculation from experiment. We know how 
very small a proportion the quantity of bile, secreted in the same 
time, bears to this. 

t Scudamore on Gout, &c. 4th edition. 



OF INDIGESTION. 45 

by derangement of the digestive tube ; its secre- 
tions become vitiated, and either deficient, or in 
excess. Whether the irritating cause be at the be- 
ginning local, as from an injury, or general, as from 
fever, it is soon propagated to this highly sensitive 
part. 

Vague observation has considered the black, 
bloody stools, as morbid discharges from the liver; 
but an attentive consideration of the phenomena, 
and of the attending circumstances, inclines one to 
look upon them as diseased secretions from the in- 
ternal surface of the digestive canal ; and this opi- 
nion gains confirmation from the appearances 
presented on dissection. Bloody motions, says Dr 
Marshall Hall, are "affections of much more fre- 
quent occurrence, than is generally imagined, in 
abdominal derangements." He speaks of vomiting 
of blood, as being not unfrequently combined with 
it; and adds, "the two diseases appear to be similar 
affections of different parts of the alimentary 
canal" "In several cases, the patient has awoke 
in the morning with blood in the mouth."* This 
last symptom, which must have occurred to every 
medical man of much practice, in cases of deranged 
general health, does in no small degree strengthen 
the conviction, that such black evacuations are de- 
rived from the bowels, and not from the liver. 
When the digestive tube is much deranged, the 
irritation extends throughout, from the mouth 

* Essay on the Mimoses, 2d edition, page 74. 



46 NATURE AND SYMPTOMS 

even to the anus : — the mouth is parched and hot, 
and the tongue coated with an unnatural secretion ; 
at the other extremity of the canal, there is heat, 
uneasiness, and piles; both, though situated at so 
great a distance from each other, are consequences 
of the same cause. In like manner, irritation of 
the internal membrane of the intestines and sto- 
mach, accompanied with evacuations of blood, is 
carried by continuity of surface to the same mem- 
brane, lining the mouth ; and the bloody state of 
this visible part of the organ becomes a pretty 
sure criterion, in what way the internal parts also 
are affected. We cannot be surprised, if a simila- 
rity of action pervades the whole surface, and a 
hsemorrhagic tendency appears throughout. "If 
pains of the abdomen are observed, if the skin is 
burning hot, the pulse frequent; if the dejections 
are slimy, membraniform, or bloody, we may be 
satisfied that the intestine is the seat of more or 
less intense inflammation/' Sometimes, however, 
"sanguineous evacuations have been observed to 
take place per anum in individuals, whose intestinal 
mucous coat was found sound after death. These 
passive haemorrhages are analogous to those which 
take place in many dropsical individuals, at the inter- 
nal surface of the serous membranes of the chest and 
abdomen ; they are similar to the haemorrhages, of 
which the skin, the cellular tissue, and the syno- 
vial membranes, become the seat in scorbutics.^* 

* M. Andral, Jun. on the Pathological Anatomy of the Diges- 
tive Tube. 



OF INDIGESTION. 47 

" It seems probable, that the stools, which resemble 
pitch, are principally composed of diseased secre- 
tions from the internal surface of the intestines, 
since they do not seem like the residue of the food, 
or discharges from the liver.*" 

Mr Abernethy, in referring to cases in which 
there were discharges downwards of black blood, 
together with other morbid matter, says, " I ex- 
amined the bodies of several persons who died un- 
der attacks of this nature, and found the villous 
coat of the alimentary canal highly inflamed, swoln, 
and pulpy. Bloody specks were observed in vari- 
ous parts ; and sphacelation had actually taken place 
in one instance. The liver was healthy in some 
cases, and diseased in others."! Again he writes 
(page 47), " where the disordered state of the 
bowels had been of longer duration, I have found 
the villous coat of the intestines swoln, pulpy, 
tinged with blood and apparently inflamed, and 
sometimes ulcerated ; and these appearances have 
been most manifest in the large intestines." 

In the Medical Repository for 1823, there is 
a case of diseased peritoneum and intestines, 
where the stools, in the beginning of the com- 
plaint, resembled ink, and towards its termination 
were of a light colour, purulent, and very offen- 
sive. As it shows the connexion which black, 

* Abernethy's Observations on the Constitutional Treatment 
of Local Diseases. 

t Observations on the Constitutional Treatment of Local Dis- 
eases. 



48 NATURE AND SYMPTOMS 

fetid stools have with intestinal irritation and dis- 
ease, I have inserted an abstract of it here: — ■ 

"Michael Slater, aetat. 31, was admitted into St 
Gile's Parochial Infirmary, Octobers, 1822, hav- 
ing a tumour of considerable magnitude situated 
on the right side of the abdomen, attended with 
frequent pain and vomiting, extreme emaciation 
and hectic symptoms. He stated that he had been 
ill five months ; that his symptoms were occasional 
pain about the navel, which he considered of a 
colicky nature ; vomiting, and dark-coloured eva- 
cuations, the latter of which he described as re- 
sembling ink; and that about a month after these 
symptoms had come on, he discovered a small 
tumour on the right side of the abdomen, which, 
with his other symptoms, had continued gradually 
to increase." — "He died December 13th — About 
three weeks previous to his death, a distressing 
diarrhoea came on; his evacuations, which had 
hitherto been scanty, and not procured without the 
aid of medicine, now became copious, of a light 
colour, purulent, and very offensive." — "Dissection. 
— The peritoneum lining the abdominal muscles 
was found remarkably thickened (the thickening 
varying from one and a half to two inches) by a 
substance somewhat resembling fat, but much 
more firm. On exposing the intestines, an ap- 
pearance presented itself, which at first seemed 
difficult to unravel : on more minute examination, 
however, it was evident that the tumour was 



OF INDIGESTION. 49 

formed by the same thickening or organized de- 
position already described, and which extended 
more or less over the whole surface of the perito- 
neum. The parts, more immediately forming the 
tumour, were the lower portion of the ileum and 
ascending colon, which, having become agglutinated 
by coagulated lymph, formed an immense and 
compact mass. On the anterior part of this 
tumour, was an opening formed by ulceration, 
through w T hich a large quantity of matter had escap- 
ed into the cavity of the abdomen, which, in all 
probability, was the immediate cause of death. 
On following the course of the outer opening, a 
cavity was laid open, occupying its central part, 
and extending about eight inches from side to side, 
through which all excremental matter must have 
passed for some time previous to death, the struc- 
ture of the intestines being at this part totally de- 
stroyed by ulceration ; consequently, there were four 
openings communicating with the cavity, formed 
by the ascending colon on one side, and the in- 
ferior part of the ileum on the other. The in- 
testines, through the greater part of their course, 
were considerably constricted. The ureter and 
pelvis of the right kidney were greatly distended 
with urine. The lungs were free from tubercles, 
and appeared perfectly healthy. The remaining 
viscera were natural." 

The black vomit, so often present in fatal cases 
of the yellow fever of tropical climates, was form- 



50 NATURE AND SYMPTOMS 

erly thought to be a morbid secretion from the 
liver, and the black stools common in that disease 
were also considered bilious; indeed, many of the 
incorrigible sticklers for liver complaints may still 
regard them as such : but close observation, and 
repeated dissection, have clearly demonstrated the 
former to be a diseased secretion from the stomach, 
and the latter vitiated discharges from the bowels. 
They are unquestionably of similar character to 
the melaena, and hematemesis, of temperate climes, 
differing from them only in intensity. In the 
severer examples of this frightful fever, " the vomit- 
ed matter is rarely bilious; it is a pituitous or ropy 
liquor, with numerous darker coloured flakes: 
sometimes clots of blood entangled in mucus, ap- 
parently portions of the inner coat of the stomach, 
are brought up in gulping ; — if the body be open, 
the stools are black, smooth like tar or molasses, 
and offensive ; — blood, sometimes, without mixture, 
discharges itself gradually by the anus, sometimes, 
mixed with connected portions of mucus — the inner 
coat of the alimentary canal — it passes off at in- 
tervals in large evacuations" In the aggravated 
form of this malady, " haemorrhage from the nose, 
oozings of blood from the ears, gums, and in short, 
from the whole track of the alimentary canal,/rom 
the mouth downwards, are observed on manvoc- 
casions." On examining the bodies of those who 
die of yellow fever, " the blood vessels of the sto- 
mach and intestines are found much distended, but 
actual inflammation is rarely apparent; the ap- 



OF INDIGESTION. 51 

pearance of the inner surface is seldom uniform 
through the whole, — the veins are generally dis- 
tended ; but besides this, the inner surface of the 
stomach often exhibits large spots, or circles of a 
bright red, resembling actual inflammation ; in the 
centre of which, are frequently seen small points, 
like beginning gangrene ; the villous coat is also 
loose, in the act of separation, and actually separa- 
ted in some places. In the second form of this 
fever, more frequently than in the other, the colour 
of the inner coat of the intestinal canal is like 
brick-dust, the coat hanging loose, and almost se- 
parated. Sometimes this takes place uniformly 
through the whole track ; sometimes it is confined 
to particular places, or a congeries of distended 
blood-vessels, entangled in the mucous membrane, 
appear in clusters, to bespangle the surface with 
bloody spots ; the cavity is sometimes also lined or 
filled with black grumous blood.''* It is true, 

* Jackson's Outline of the History and Cure of Fever, page 
187, et seq. (1798). I cannot but remark here, that in this ex- 
cellent work we find the more correct pathology of fever, both 
endemic and contagious, and its rational treatment, precisely the 
same as they have been lately recognized and established among us, 
and which are now the very reverse of what were entertained and 
followed by the great body of medical men in the year ninety- 
eight. The different modifications of fever, of late so ably illustra- 
ted by Dr Armstrong, and other recent authors, were clearly point- 
ed out by Dr Jackson in the last century; and these writers add little 
to the means of cure that were then described and used by him. 
He has distinctly and correctly noticed the simple, inflammatory 
and congestive forms of febrile diseases; and, regardless of opposi- 
tion and reproach, blood letting, purgatives, and aperients, cold 



52 NATURE. AND SYMPTOMS 

that in the more aggravated forms of yellow fever, 
the liver appears sometimes uncommonly large, 
black and distended, as if suffocated with blood; 
but this is no more than what takes place in the 
head, lungs and other viscera. 

In the second volume of Les Memoires de la 
Societe Medicale d'Emulation, there is a valuable 
case, in which blood first passed from the stomach 
by vomiting, and then downwards from the bowels, 
attended by distention, constant distress, failing, 
irregular pulse, and cold sweats ; the bowels obsti- 
nately refusing all impression from purging and 
injections ; the mechanical irritation of the rectum, 
by the introduction of a large gum catheter its 
whole length, was followed by the evacuation of 
three large pots full of black, bilious matter ; the 
abdomen was thus unloaded, and the patient, to all 
appearance expiring, gradually revived, and eventu- 
ally recovered. The same thing happened a se- 
cond time, and was relieved by the same means. 

and warm affusion, with free ventilation, and exposure, to the air, 
were his chief remedies. Thus we see, that above five-and-twenty 
years ago, when the phantoms, debility and putrescency, occupied 
the minds of all other physicians, and worse than paralized their 
energies, the enlightened Jackson alone possessed clear, compre- 
hensive, and correct views respecting the pathology of fever, and 
was pursuing a line of practice at once rational and successful. 
These are unequivocal marks of transcendent genius and talent, of 
which few can boast. Indeed, all the writings of this amiable 
man evince a philanthropy, and an extent and accuracy of ac- 
quaintance with medical philosophy, that entitle them to univer- 
sal attention and admiration, and which rank their author among 
the best of men, and the most useful and distinguished of medi- 
cal writers. 



OF INDIGESTION. 53 

The distinguished M. Portal has lately turned 
his attention towards the investigation of the na- 
ture of these black evacuations, and has published 
a memoir on the subject. He believes that the 
black matter is not bile, having no trace of bitter- 
ness, nor dissolving, like bile in cold water, nor giv- 
ing any green colour to the water ; but that it is pure 
blood, which, in the bodies of those examined after 
death, mav be seen to transude from the blood- 
vessels of the stomach and intestines. 

Mr Howship has attended several individuals, 
labouring under severe pains and relaxation in the 
bowels, with bloody stools; and after considerable 
attention to these complaints, he is persuaded of 
their being essentially a morbid affection of the 
villous coat of the bowels. In one case, which 
terminated fatally at the second attack, he had an 
opportunity of ascertaining this fact, by dissection ; 
and the examination shows, that such discharges 
take place from functional disorder as well as from 
actual disease, which is agreeable to the extensive 
experience of M. Andral, Jun. : — "The bleeding 
had taken place from the capillary or exhalent 
vessels, upon the internal surface of the great in- 
testine, and although it was evident that every 
part of the bowel had been a bleeding surface, no 
part had suffered ulceration, nor was any part in- 
flamed, though the whole was red."* 

* Observations on the Diseases of the Lower Intestines, page 
99 (3d edition). 
H 



54 NATURE AND SYMPTOMS 

The darker fluids, passed in cases of abdominal 
disorder, sometimes resemble thick, black, bilious 
stools ; at others, they look like grumous, unhealthy 
blood. As these different appearances alternate 
in the same individual, under a single attack of 
disorder; and I have here produced sufficient 
evidence to prove, that the bloody motions are, for 
the most part, entirely discharged from the intes- 
tines ; this fact becomes an additional and power- 
ful support to the opinion, that the black, tar- 
like evacuations, are likewise derived from the 
same source. 

Dr Ayre, in some observations on disorders of 
the liver, considers the blood discharged by vomit- 
ing and purging, to be poured forth from the 
liver ; but his arguments in favour of this origin 
of the complaints are very inconclusive and un- 
satisfactory, and are totally uncorroborated by any 
facts. He relates the appearances, on dissection, 
of two fatal cases of melaena ; but so far from being 
conclusive, they throw little or no light upon the 
subject. If any thing is to be gathered from them, 
it is that the bleeding took place from the intes- 
tines. The first is a case of a girl of thirteen 
years of age : — the liver, on being cut into, had a 
blanched appearance, and scarcely any blood issued 
from it, or from the vessels leading to it; and 
from this circumstance it is assumed, that the 
blood discharged, per anurn, must have come from 
that viscus. This will be allowed to be very in- 
firm ground for such a supposition ; besides patho- 



OF INDIGESTION. 55 

logy can receive no assistance from the appearances 
in a single case. The liver was quite natural in 
its texture and bulk, and it is stated that the con- 
tents of the abdomen were perfectly healthy. I 
confess, I feel inclined to inquire, whether the in- 
ternal surface of the bowels w r as examined through- 
out ? as there is reason to fear, that in such exam- 
inations, this minute inspection of the internal sur- 
face of the whole of the bowels is too often neg- 
lected. In the second case, which occurred in a 
woman aged seventy-five, it is said, " the same 
appearances were exhibited as in the former case." 
Here, however, we are informed, that the intestines 
appeared equally blanched with the liver. Indeed, 
nothing remarkable presented itself, but the general 
deficiency of blood in the thoracic and abdominal 
viscera ; but from this Dr Ayre concludes, that 
the haemorrhage certainly took place from the 
liver ! — " This organ was completely emptied of 
its blood, as well as the right auricle and ventricle 
of the heart, and the large veins leading to it. 
The structure of the liver, and all the other organs, 
notwithstanding her age, appeared healthy. Both 
the liver and intestines had a blanched appearance. 
The latter were lined throughout with a dark- 
coloured slimy matter, similar to what was passed 
after the hemorrhage stopped"* Is not the last 
sentence unfavourable to the author's hypothesis ? 

* Practical Observations on Disorders of the Liver, by Dr Ayre, 
page 29, et seq. 



56 NATURE AND SYMPTOMS 

Does it not afford evidence of the disordered, and 
highly excited state of the interna] surface of the 
intestines, and strengthen the probability of the 
bleeding having been derived from them ? 

I believe these cases of Dr Ayre, and his 
reasoning, will generally be considered very mea- 
gre support to his opinions on this subject, after 
the facts brought forward above in confirmation of 
the reality of a quite contrary sentiment. We 
have seen, that frequently in these affections, blood 
is discharged from the mucous membrane of the 
mouth, affording presumptive proof of the same 
membrane lining the stomach and bowels being 
the true seat of the disorder, which gives rise to 
vomiting and purging of blood ; since a variety of 
facts show that this membrane, from its continuity 
of surface, is liable to be similarly affected through 
its whole extent, and therefore the affection of 
the mouth becomes an index to the state of the 
stomach and bowels. We have likewise found 
that the results of M. Andral's indefatigable atten- 
tion to disorders and disease of the abdominal vis- 
cera, and of his extensive experience therein, is, 
that when the dejections are bloody, we may be 
satisfied the intestines are, for the most part, the 
seat of more or less intense inflammation. That 
Mr Abernethy has almost invariably found disease 
in the large intestines after death, under such cir- 
cumstances, in the numerous examinations he has 
made ; their villous coat being swollen, pulpy, and 
tinged with blood. That in the concentrated en- 



OF INDIGESTION. 57 

demic fever of warm climates, where vomiting and 
purging of blood are so frequent and alarming, and 
the stools look like tar or molasses, the proofs of the 
exceeding severity of the intestinal disease are incon- 
trovertible. And that the protracted experience of 
M. Portal convinces him, that the blood may be seen 
in such states transuding from the blood-vessels of 
the alimentary canal, after death, which perfectly ac- 
cords with the observations of Mr Howship. These 
are multiplied proofs of the paramount intensity of 
intestinal irritation; and in their number and weight, 
they form a striking contrast to the scanty testi- 
monies, and gratuitous assumptions of those, who 
will still harp on the insensible liver, and who can 
see little else than an affection of this organ in all 
abdominal disorders. 

Dr Ayre's book on marasmus, in assigning that 
state of body as possessing its common origin chief- 
ly or exclusively in liver disorder, appears to me 
to carry us far backward in pathology. The chief 
feature of it is a distorted one ; and if it has met 
with that favourable reception from the profession, 
which some seem to assert it has, I cannot but 
consider it as another proof of the false light which 
overhangs this part of medicine in our country. 
Marasmus is much oftener met with as consecu- 
tive to intestinal irritation and disease, than to he- 
patic affection ; and it is to the first of these evils 
we are to look for the most exquisite examples of 
this species of consumption. The following case 
exhibits the principal features of this malady, as it 



58 NATURE AND SYMPTOMS 

commonly occurs, with the most usual appearances 
on dissection. We are here presented with a 
series of phenomena, w T hich, Dr Ayre would have 
said, had their origin in the disordered action of 
the liver ; but which the knife of the anatomist 
proves to be dependant upon intestinal lesion alone ; 
and I appeal to familiar experience to verify what 
I advance, that the symptoms and morbid appear- 
ances of this case may be safely received, as exhibit- 
ing those which accompany and constitute ordinary 
marasmus, when it terminates fatally. The diar- 
rhoea, and the light clay-colour of the stools at one 
period, would no doubt have been considered by 
the abettors of the bilious theory, as conclusive on 
the subject of the disorder's being chiefly, or alto- 
gether, one of the liver; but we find this organ to 
be healthy, and that the morbid phenomena were 
confined to the bowels. 

"Master M., a child of three years old, was at 
school in good health till January 1810, when he 
became poorly, and was supposed to have taken 
cold. His appetite was impaired, and his bowels 
were relaxed. This, however, was scarcely noticed 
for some time. He enjoyed his usual amusements, 
and it was expected his complaints would wear off 
again. After some weeks, however, the child was 
sent home with a severe diarrhoea, the abdomen 
much swelled, and at times very painful. When 
sent to school he was a very hearty and strong 
child, but on his return was much altered, weak, 



OF INDIGESTION. 59 

and emaciated. As the disorder continued to in- 
crease, he became heated in the skin." 

During the existence of these symptoms, the child 
was improperly* treated, by a very ignorant apo- 
thecary, being stuffed with mutton chops, beef 
steaks, and porter— the apothecary declaring that 
he would soon recover: but instead of this, he 
grew worse and worse, till his case was pro- 
nounced by the same man to be hopeless. " He 
still continued to grow thinner, and the fever, which 
was at first occasional, now became constant. The 
diarrhoea, however, was apparently on the decline, 
and this seemed to afford a ray of hope. The mo- 
tions were, on some days, not more frequent than 
natural, but every now and then violent fits of rest- 
lessness and crying came on, and he complained 
of the 'belly-ache.' 

"The abdomen was exceedingly tumid and hard, 
and excessively painful whenever in the slightest 
degree pressed. His water was observed to be 
becoming high-coloured ; it was also rendered in 
diminished quantity. The appearance of his stools 
had changed ; they were of a light clay-colour, as 
usually observed in disorders where the bile is 
prevented from flowing into the intestine. He 
had once, about this period, a sickness at the sto- 
mach, with vomiting ; on which occasion the mat- 
ter thrown up was found exactly to resemble, in 
smell and appearance, that which was passed by 
stool. 

" At this time, I was first desired to see the 



60 NATURE AND SYMPTOMS 

child. The body was reduced almost to a shadow, 
the belly much swollen, very tense, and extremely 
painful. There was an obscure fluctuation in the 
abdomen. The motions were at tjiis time less fre- 
quent than in health. The child was perfectly 
sensible, and always called for his chair, when 
necessary. The pulse was pretty good, and beat 
120 in a minute, but the little remaining appetite 
had now failed, so that he took nothing." 

A suitable treatment was now instituted, but, 
after languishing a few days, he expired. 

" Examination. 

" The body was inconceivably emaciated. On 
laying open the abdomen, the peritoneum was found 
in many parts adherent to the viscera. The omen- 
tum was considerably thickened by inflammation 
and disease. The whole bundle of intestines was 
found involved in one confused mass of adhesions. 
This had been consequent to a very extensive ef- 
fusion of coagulable lymph into the cavity of the 
abdomen, in which was also a quantity of serous 
fluid, that was removed in the course of the exami- 
nation. 

"This mass of coagulated lymph was next cut 
into, when a quantity of brownish red fluid gushed 
forth, and with it the skins of some raisins. This 
circumstance proved, that some parts of the coats 
of the intestines had given way. The incision 
was then extended, so as to expose more perfectly 



OF INDIGESTION. 61 

the cavity'of this preternatural cyst ; by this means, 
a circular hole, about a quarter of an inch in diame- 
ter, was discovered in the side of the small intes- 
tine. From this, the contents of the bowels had, 
in the first instance, escaped, and by it the fluids 
still ran freely out." 

# *■ * * * * 

" On closer examination, the villous coat of the 
small intestines was in several places found to be 
destroyed by ulceration ; but in no part, except 
where the opening had been already detected, was 
the ulceration deeper than the muscular coat of the 
bowel."* 

Dr Pemberton called the marasmus of children, 
the infantile remittent fever,f and considered it de- 
pendant upon derangement of the bowels. He, 
however, professed himself ignorant of the patho- 
logical anatomy of the abdominal viscera, in this 
disorder, from not having enjoyed sufficient oppor- 
tunities of examining the bodies of those who died 
of the complaint ; but he has noticed one fatal case 
of this description, at the examination of which he 
was present. Here all the solid viscera of the ab- 
domen were healthy, and the bowels were evident- 
ly the chief seat of the affection. Still, nothing 

* Howship's Observations in Surgery and Morbid Anatomy, 
page 264. 

t Treatise on the Diseases of the Abdominal Viscera, page 158. 

I 



62 NATURE AND SYMPTOMS 

is said by him of the state of the internal surface 
of the intestines ; probably, they were not examin- 
ed, at least, with the care and attention that is de- 
sirable, in every such affection, as the phenomena 
immediately visible on removing the abdominal 
muscles, &c. render it probable, that inflammation, 
or some organic lesion, would have been discovered 
in their mucous membrane, had it been so examin- 
ed. The subject of the case was a child of four 
years old ; and Dr Pemberton remarks, " the belly 
was swelled to a very large size, but there was not 
the least appearance of inflammation on the peri- 
toneum, or upon any of the viscera of the abdomen, 
or any fluid in the cavity. The liver, pancreas, 
spleen, and kidneys, were natural ; the mesenteric 
glands were in a small degree enlarged: — The in- 
testines were distended to an enormous size, so that 
the colon measured seven inches in circumference, 
and all the other intestines were, in like manner, 
greatly distended"* 

When the stools are white, the secretion of bile 
is unquestionably suppressed ; or, if secreted, it is 
prevented passing into the duodenum; but the 
copious, frothy stools, which look like a quantity 
of yeast, or resembling soft pudding, seem 
essentially connected with a very disordered or 
diseased condition of the bowels, especially the 
larger bowels ; and the appearances presented, on 

* Treatise on the Diseases of the Abdominal Viscera, page 167. 



OF INDIGESTION. 63 

dissection of several fatal cases, set this ques- 
tion quite at rest.* 

Dr Blackall has favoured us with a very in- 
teresting case, where the patient voided, during 
life, large quantities of a matter resembling yeast, 
in colour, fluidity, and effervescence. The man 
w r as supposed to have a liver complaint \ and mer- 
cury was accordingly given to him ; by its effect 
on the internal surface of the bowels, he mended 
a little under its use, but afterwards relapsed, and 
died ; when dissection showed, that the mischief 
had its seat in the bowels only, the liver being 
healthy. He suffered altogether more from flatu- 
lency, dyspepsia, and dejection of spirits, than ±rom 
any precise pain: sometimes, however, when 
questioned, he would acknowledge an obscure un- 
easiness and fulness towards the lower part of 
the abdomen, on the right side. "The liver was 
natural, both in size and structure, and the gall- 
bladder full of a yellow healthy bile; but on 
tracing the intestines, we found the caecum, and its 
appendix with some of the neighbouring parts, 
involved in a mass of scrofulous adhesions, which, 
when taken out, and dissected at leisure, presented 
the following appearance: — The disease began 

* A very dangerous and not unfrequent error is that of re- 
ferring to a disordered liver to explain the cause of those 
mucous and gelatinous discharges from the bowels, proceeding 
solely from disease seated in the tract of the large intestine con- 
sisting ordinarily of high irritation or inflammation in one or more 
of the tissues. — Edit, 



64 NATURE AND SYMPTOMS 

about two inches above the termination of the 
ileum. Its inner membrane was, to the extent of 
a crown-piece, covered with spots of lymph, and 
there were two or three small ulcers. The whole 
of the inner membrane of the caecum was com- 
pletely destroyed by ulceration, and its other coats 
much thickened ; the beginning of the colon was 
in the same state, for five or six inches further 
nearly healthy, and then again, for a short space, 
thickened and ulcerated, in a spot where, by a sort 
of unusual course of the intestine, it had doubled 
down upon the caecum.'' Dr Blackall adds, "I 
apprehend a slight degree of this disease to be not 
unusual. I have seen four cases of it to an extra- 
ordinary extent, where the discharges, by stool, 
greatly resembled yeast in their appearance, and, 
in one instance, were nearly raised by their 
effervescence over the sides of the vessel. All the 
patients had this in common, that they died ex- 
tremely emaciated, and after a most tedious linger- 
ing. In all there was much flatulency, and in 
some, a croaking noise of air, apparently, seated in 
the ascending arch of the colon, and sometimes 
producing such a projection there, as almost to 
give suspicion of a ventral hernia:" symptoms, I 
presume, strongly indicative of intestinal disease. 
It is very correctly observed by this judicious 
physician:— "Writers describe this remarkable 
complaint imperfectly, and, when they notice the 
occurrence of yeasty discharges, they generally 
seem to refer them to an obstruction of the liver 



OF INDIGESTION. 65 

exclusively. But many circumstances, parti- 
cularly the preceding dissection, prove the large 
intestines to be much engaged in this disorder."* 
In the Medical Eepository for October 1822, 
there is the following : — " We had, last year, an op- 
portunity of inspecting the body of a naval officer, 
who had served long in the West Indies, and 
who died, at an advanced period of life, of diarrhoea 
gypsata. On dissection, the liver was found tuber- 
culated, the spleen enlarged, and condensed in 
structure; the pancreas was much enlarged, and 
presented the appearance of incipient schirrus, in 
more than one part. The mucous coat of the di- 
gestive canal, from the mouth to the anus, pre- 
sented marks of disease, which were greater in 
some situations than in others. It was generally 
more vascular than natural, and, in many places, 
was inflamed and ulcerated. The inflamed 
parts surrounding the ulcerations were much 
thickened. The muciferous, or follicular glands, 
possessed a dirty-grey colour, and were enlarged 
to various sizes, so as to give, in some places, a 
granulated appearance to the mucous surface ; in 
others, a number of small ulcers were dispersed 
through it, apparently in the situation of the orifices 
of the mucous glands. These ulcers penetrated 
deeply into the villous coat, and were in some parts, 
distinct ; in others, they coalesced, and gave rise to 

* Dr JBlackall's valuable Observations on Dropsy, page 108, 
etseq. (1813). 



66 NATURE AND SYMPTOMS 

extensive ulcerations, with thickened and inverted 
edges, or to a foul, dark and rugged condition of 
the internal tunic. These lesions were more ex- 
tensive in the rectum, colon, lower part of the 
ileum, duodenum, in the vicinity of the pylorus, 
in the pharynx, and more slightly in the jejunum, 
and commencement of the ileum. The florid, 
thickened, ulcerated states of the palate and fauces, 
were apparent for some time before the death of 
the patient." 

The editors of the above journal have been led 
to take the same view of the pathology of this 
peculiar kind of diarrhoea, as is here maintained. 
On this subject, they wisely differ from Dr Good* 
(who is evidently too fond of making the liver a 
capacious vortex of disease), observing, that from 
the character of these derangements, as well as from 
other circumstances, they have concluded the dis- 
ease to be essentially one of the follicular glands 
of the intestines, from its commencement, which 
terminates in their enlargement and ulceration; 
and that the alvine dejections are characterized 
by the copious, and vitiated secretion to which 
their disorder gives rise. They had two cases of 
this disorder under treatment, when this case was 
written, neither of which had received any bene- 
fit from the active remedies prescribed. 

Not only does an impartial consideration of the 
attending phenomena, and of the economy of the 

* See his " Study of Medicine," vol. i. 



OF INDIGESTION. 67 

digestive tube, contrasted with that of the liver, 
lead to the conclusion, that, for the most part, all 
the cases of abdominal disorder, in which copious 
stools of either black, yeasty, bloody, or any other 
coloured matter are conspicuous, are essentially 
connected with a permanent excess of irritability 
in the intestines, wholly independent of the state 
of the liver ; but I believe the dissections of the 
many fatal examples on record more than bear me 
out in the assertion. In a considerable majority 
of these instances, the liver presented no traces of 
disease or inflammation, while the organic lesions 
of the intestines were almost invariably present; 
— either simple inflammation, of various shades ; 
thickening or softening of one or more of the coats ; 
tubercles; or ulcerations, being conspicuous, and 
not seldom unaccompanied by disorganization in 
any other of the abdominal viscera. The causes, 
symptoms, and post mortem appearances of ordi- 
nary diarrhoea, dysentery and lientery, I consider 
as clearly pointing them out to be originally dis- 
eases of the mucous surface of the bowels; the 
liver, if disordered, being affected secondarily. 
The same may be affirmed of cholera morbus.* 
These being complaints remarkable for the quan- 

* The following quotation from my Treatise, entitled " Modern 
Domestic Medicine/' third edition, page 265, fully explains my 
sentiments in respect to the real seat and character of cholera. 

"It has been usual with medical writers to consider severe 
affection of the liver, or of the bile ducts, to be the immediate 
cause of cholera (in other words, in what the disease essentially 



68 NATURE AND SYMPTOMS 

tity of the intestinal discharges that take place un- 
der them, they lend important proof from analogy, 
of the correctness of the pathology here advanced, 
of the disorders which form the subject of consi- 
deration in these pages. 

M. Andral Jun., whose laborious and extensive 
researches on the pathological anatomy of the di- 
gestive tube, entitle his sentiments on this point 
to much deference and attention, remarks, that 

consists), but the present author is convinced, that it is really 
owing to high irritation and spasm of the stomach and small in- 
testines, for nothing can explain the severity of the symptoms in 
this disease, the extensive chain of influence excited, and the com- 
plete exhaustion of the living principle, which sometimes occurs 
with astonishing rapidity, but the supposition of such a condition 
of these very sensible and important organs. The imperfect 
organization of the liver and bile ducts, their dull sensibility, and 
their confined sympathies, are so apparent, as to render it im- 
possible for us satisfactorily to account for these phenomena by any 
imagined spasm centered in them." 

In regard to the nature of cholera, Dr Good observes (Study 
of Medicine, vol. i, page 268), " The general battery of symptoms 
appears, therefore, to have been opened by a spasmodic constric- 
tion of the bile ducts." Further on (page 273) he is, however, 
compelled to add, " It still remains to be ascertained why an affec- 
tion of the liver, or of the bile ducts, should be capable of excit- 
ing so extensive a chain of influence on the nervous, rather than 
on any other system." In the copy which I possess of Dr Good*s 
work, I find on referring to it at this time, that I had pencilled 
in the margin opposite to the former quotation, the following ob- 
servations, which I would transcribe into these pages. " If we 
reverse what is here said of the relative condition of the biliary 
organs, and the alimentary canal, and consider the 'general 
battery of symptoms' to have been opened by high irritation and 
spasm of the latter, the former participating in it, and therefore be- 
coming obstructed, we shall certainly approach much nearer the 
truth." 



OF INDIGESTION. 69 

diarrhoea, dysentery, and lientery, have been for a 
long time looked upon as diseases entirely inde- 
pendent of intestinal inflammation; but it is in- 
dubitable, that in a very large majority of cases, 
the intestines of individuals labouring under diar- 
rhoea, whether complicated or not, with dysenteric 
symptoms, present evident marks of phlegmasia. 
And he further judiciously observes, that dissec- 
tion establishes the fact that the same kind of 
organic lesions in the intestines will in some per- 
sons produce dysentery ; in others, diarrhoea. 

An objection has been raised to the idea of the 
yeasty, dark, black motions, frequently voided in 
the prevailing disorders of the digestive organs, be- 
ing vitiated secretions from the bowels; because 
all the secretions poured into the intestines, or 
supplied by them, except the bile, are for the most 
part colourless : and it has therefore been urged, 
that any change from the natural appearance which 
takes place in the faeces, must result from a change 
of the bile. The former assertion is true, if it be 
confined to a state of health ; but how completely 
is it invalidated by familiar experience, if it be 
meant to apply also to a diseased condition. The 
urethra of a healthy man secretes a colourless, 
limpid fluid; but when irritated and disordered, 
its secretions become white, yellow, or green, 
opaque and stinking. The same change takes place 
under disorder in the serous membrane lining the 
chest, whose healthy secretions are without col- 
our; and so it is with the secreting membrane of 

K 



70 NATURE AND SYMPTOMS 

the bowels, and of every other part. In health, 
their secretions are for the most part colourless, but 
no bounds can be set to the change they may un- 
dergo when exposed to irritation : then they are, 
at different times, found of all colours, from the 
pure inodorous white to the concentrated offensive 
black. It is not a little surprising, therefore, that 
the colour of the secretions of a healthy part should 
be brought forward to prove that the same appear- 
ances are exhibited by them under disorder and 
disease. 

We have enumerated the power which mercury 
possesses, in restoring unnatural stools to their 
healthy appearance, among the causes of the sup- 
posed frequency of liver complaints. The opinion 
which has much prevailed of late in the profession, 
that this mineral exercises a specific action on the 
liver, far more immediate and efficient than it ex- 
ercises on any other secreting organ, is an error 
that is grown out of the striking change often 
produced by it in discoloured, offensive motions, 
and from its almost exclusive influence over the 
acute bilious disorders of India. If it is shown in 
these pages, that such unnatural alvine evacuations 
are much more closely connected with an un- 
healthy state of the internal membrane of the bow- 
els than with disorder of the hepatic viscus, it has 
been proved, that the notion that mercury exerts a 
greater power over the secretions of the latter, than 
it does over those of the former, derives no founda- 
tion or strength from the signal change in the 



OF INDIGESTION. 71 

stools just alluded to. In the acute bilious dis- 
orders of India (as they are called), calomel is un- 
questionably superior to every other remedy. In 
them it certainly seems to originate specific effects 
and requires to be employed in large, quickly re- 
peated doses ; but nothing satisfactory can be de- 
duced from this circumstance, in regard to its 
having a more direct and powerful influence on the 
liver, than on the intestines and mesentery, in the 
ordinary chronic maladies of the abdominal viscera 
met with in this country ; for independent of the 
sensible and great difference in the complexion 
and severity of these affections of the two climates, 
my researches lead me naturally to question, 
whether this unequalled efficacy of calomel, in the 
diseases of the East, is owing to any such superior op- 
eration on the liver. Its use in acute hepatitis is 
certainly dependent upon an operation of this kind, 
but cholera morbus and dysentery, two of the most 
frequent and dangerous diseases of that region, and 
in which the powers of mercury are equally con- 
spicuous, are affections of the alimentary canal ; 
and it appears incontrovertible, that in the endemic 
fevers also of India, which may likewise be affirm- 
ed of the fevers of the West Indies, it is disease of 
the mucous surface of the digestive tube, that is 
principally concerned in producing the symptoms 
visible under the attacks, since the epigastric and 
umbilical regions are the principal foci of uneasi- 
ness and irritation, and this tube generally presents, 
on dissection, the most intense appearances of or- 



72 NATURE AND SYMPTOMS 

ganic lesion, and sometimes none are found else- 
where. I think it will not be said by medical 
men of correct observation, after due reflection on 
the results which have followed their employment 
of mercury indifferent abdominal maladies, that, in 
actual practice, they have found it possess a 
greater curative power over unequivocal disorder 
or disease of the biliary organs, than it has in a 
similar condition of the intestines. The dis- 
orders, popularly termed bilious, in reality have 
their seat in the stomach and bowels ; and if the 
mercurial oxides are commonly of imperfect use 
in intestinal disease,* it should be remembered 
also, that in disease of the liver, it is no longer a 
doubt whether they are of much or little service. 
The real fact is, that this mineral generally pos- 
sesses, in a higher degree than any other known me- 
dicine, the power of changing the condition of ac- 
tion in the extreme vessels of the circulating system 
throughout ; it is for this reason, that it is so im- 
portant an instrument in the hands of the physi- 
cian in so many and apparently dissimilar com- 
plaints ; and it is proved by experience, to exert no 
greater influence over the secreting vessels of the 
liver, than it does over those of the intestines and 
mesentery.f 

* It should be remarked, that I here speak of positive or or- 
ganic disease. 

t It would appear, that the rationale of the operation of calomel 
is so imperfectly understood, as to occasion much apparent in- 
consistency in regard to its use. We find it denounced by our 



OF INDIGESTION. 73 

3. Of all our organs, the stomach is that which 
in general the most effectually resists positive dis- 
ease. It will sustain considerable irritation and 
disorder for a long series of years, without under- 
going any alteration in its structure ; but, from the 

author in one place as a "highly stimulating agent," whilst here 
it is held up as unquestionably superior to every other remedy in 
the acute bilious disorders of India, when "employed in large, 
quickly repeated doses." 

So far as our observation extends, calomel is the only article 
in the class of purgatives which may be advantageously adminis- 
tered in acute diseases where the first passages are the seats of 
irritation and even inflammation. In such cases instead of aggra- 
vating the symptoms, as every other cathartic with which we are 
acquainted would do, its immediate effect, when given alone, is 
generally to reduce diseased action and allay irritation. Ap- 
plied externally to irritated and inflamed surfaces, calomel of- 
ten exerts the most positive soothing effects. We have often 
witnessed these in hepatic and other cutaneous affections, and 
when employed as an injection in gonorrhoea. We are sensible 
that in the present condition of our knowledge of the modus ope- 
randi of medicines, the facts here adduced must appear at vari- 
ance with the new medical doctrines, for which we profess a 
high regard, but as we never can be persuaded to abandon well 
demonstrated facts, we shall trust to further illumination from 
physiological sources to clear away the mystery. 

Our remarks are intended to apply more particularly to the 
medicine when administered with a view to its immediate advan- 
tages in acute diseases, and not to its operation when prescribed 
as an alterative, the rationale of which we conceive to be of a 
totally different kind. The secondary effects of this medicine, 
such for example as the general irritation and salivation, so apt 
to ensue upon the subsidence of the disease for which it may have 
been administered, constitute a most formidable objection to its 
common employment. Happily, its use in all ordinary cases can 
be dispensed with, and physiological medicine supplies us with 
resources, which make it seldom requisite to resort to a remedy 
that may ultimately prove dangerous. — Edit. 



74 NATURE AND SYMPTOMS 

liver possessing only very inferior vital properties, 
it is much less able to resist the disorganizing in- 
fluence of irregular or violent action ; and as it 
participates in the disorders of the first and second 
stomach, disease from this cause frequently fastens 
upon it alone, and the existing complication of evils 
sometimes terminates in death. Upon the dissec- 
tion of bodies thus affected, the liver will present 
appearances of disease, when there are no traces of 
it in the stomach or duodenum, and very few and 
slight ones in the other abdominal viscera. This 
occurrence, particularly when the patient's symp- 
toms during life did not clearly denote the exist- 
ence of hepatic mischief, which not unfrequently 
happens, has confirmed many of the profession in 
the popular notion of the exceeding prevalence of 
liver complaints, and has been another cause of 
increasing and perpetuating the error. The diffi- 
culty with which disorganization is induced in 
one, and the greater facility with which it origi- 
nates in the other organ is forgotten ; and, therefore, 
the relation which the above mentioned circum- 
stances bear to each other, as cause and effect, is 
unperceived and reversed. Instead of the organic 
injury of the liver being considered a consequence 
of long continued and severe derangement of the 
stomachic functions, it is regarded as an original, 
independent affection, and sometimes, even as the 
sole complaint, notwithstanding that the stomachic 
irritation may almost always be recognized during 
life, as the primary malady, existing long before 



OF INDIGESTION. 75 

symptoms supervene, which decidedly denote 
hepatic mischief : — thus, liver complaint still en- 
grosses the attention of the practitioner, and pre- 
sents itself to his imagination on all such occasions 
in the living subject ; and this reversion of causes, 
drawn with confidence from actual dissection, 
stands as a humiliating memento of the fallibility 
of medical evidence, when the physician has a fa- 
vourite hypothesis to support. 

I think there can be no difficulty in conceiving 
that disorder, or disease, may and does often exist 
for some time in the liver, without the stomach 
participating, and without the bowels being very 
sensibly affected ; but it does not consist with our 
physiological knowledge, or with observation, to 
suppose that the reverse of this ever occurs. The 
insensibilitv, and the natural functions of the for- 
mer organ, encourage this conclusion ; besides, it is 
admitted, that we are not unfrequently surprised 
in finding marked disease in the liver after death, 
when the patient during life manifested no symp- 
toms of such complaint : this gland is one of waste 
rather than of supply ; and it is reasonable to 
infer, therefore, that a partial interruption or ir- 
regularity in its healthy actions may be borne, for 
no short period, with little injury, and without its sen- 
sibly influencing the functions of the other assimila- 
ting viscera. Not so with the stomach, and small in- 
testines. They are organs of remarkable supply, 
of the most delicate and extensive connexions, and 
are the most irritable parts of the body; in conse- 



76 NATURE AND SYMPTOMS 

quence of which, they cannot be disordered 
without involving the liver in the same morbid 
association ; and it is particularly worthy of atten- 
tion in our day, that this is ordinarily the natural 
course of invasions in the disorders under review. 
Mr Abernethy, whose great improvemnts in his 
profession, demand and engage general attention, 
with all his attachment to affections of the chylo- 
poietic viscera, and partiality for blue pill, is not 
one of those who consider the liver to be the root 
of the evil in these disorders. If I understand him 
right, instead of considering this organ to be the 
chief and primary seat of invasion, as is generally 
done, he takes that view of the subject which I 
would urge upon public attention, regarding the 
stomach as commonly the first affected, then the 
intestinal canal, and lastly the liver. He remarks, 
"when digestion is imperfectly performed, the 
functions of the intestinal canal will soon partici- 
pate in the disorder of the stomach. Under these 
circumstances, the secretion of bile will also pro- 
bably become irregular.'' Again, "It is fair to 
infer, that where general disorder of the digestive 
organs takes place, those fluids which produce the 
changes which the food undergoes in them, are 
deficient or depraved ; and consequently, that di- 
gestion and the subsequent processes must be im- 
perfectly performed. The liver is likely to parti- 
cipate in the disorder, and the biliary secretion to 
be diminished or vitiated. This circumstance ad- 
mits of ocular demonstration : and I have, therefore. 



OF INDIGESTION. 77 

considered it as an evidence of a more or less 
general disorder of the digestive organs. A very 
reasonable objection may, however, be made to 
considering the derangement of the function of 
the liver as a criterion of those of the stomach and 
intestines ; since the liver is independent of the 
latter organs, and may be the subject of a disorder 
confined to itself. In some cases, also, the alimen- 
tary canal may be affected without disturbing the 
liver. Such circumstances may happen occasion- 
ally ; but they are not ordinary occurrences, and 
should be considered as exceptions to general 
rules,which do not militate against their common 
operation. In general, affections of the former in- 
fluence the functions of the latter"* 

There is reason to fear, from the almost ex- 
clusive attention paid of late to the liver, that, 
in conducting the dissections in such cases, the 
state of the digestive tube has been very often 
either partially or wholly disregarded. These ex- 
aminations have been made in a way likely to 
propagate the belief of the universal spread of dis- 
ordered and diseased liver, but not calculated to 
show the real state of the whole of the organs con- 
cerned, and the relative frequency of intestinal dis- 
ease. If the biliary organs have been found 
injured in their structure, it has been too frequently 
considered sufficient to account for every symptom 

* Observations on the Constitutional Origin of Local Diseases, 
page 42. 



78 NATURE AND SYMPTOMS 

that occurred during life; nothing was thought 
worthy of particular notice in the abdominal 
cavity after this, and the dissection has accordingly 
been hastily concluded. Had less attention been 
directed to these parts and more to the intestines, 
in examining the bodies of individuals who have 
died from a diseased condition of the assimilating 
viscera, the relative state of the latter would be 
better known, and have gained due attention. 
"It has frequently happened to us, to find the 
mucous membrane evidently inflamed, disorganiz- 
ed, and ulcerated, in portions of the intestines 
which, when seen and examined externally, had 
been regarded as healthy. An important error 
may therefore be committed, if, as is sometimes 
done, we pretend to judge of the healthy or 
morbid condition of the intestine by the appearance 
of its external surface."* 

From what has now been said respecting the 
appearance of organic injury of the liver, in pro- 
tracted disorders of the digestive organs, it must 
not be supposed that this is a common occurrence, 
in the examples we daily meet with of these 
multiform complaints, the great proportion of 
which are of recent origin. I could not pass by 
the fact of disorganization being sometimes found 
in this viscus in these cases, when there is no such 
thing elsewhere in the abdomen, without adverting 
to it as a cause of increasing, among the profession, 

* M. Andral, Jun. 



OF INDIGESTION. 79 

the idea of the great frequency of this disease; but 
as I believe it may be safely asserted, that fifteen 
cases out of sixteen, of what are popularly termed 
bilious complaints, are disorders of the digestive 
canal; so I think it indisputable, that in four 
cases out of five, of what are usually designat- 
ed confirmed liver diseases, there is no positive 
disease in the hepatic region, the affections be- 
ing examples either of aggravated functional 
disorder of the stomach and intestines, or of 
disease in some part or parts of their course. 
When chronic inflammation, induration, ulcera- 
tion, or any other organic lesion, does super- 
vene an unhealthy condition of these parts, I think 
morbid anatomy proves, that such consequences are 
much more frequently recognized in the bowels, 
than in the gland secreting the bile. Among the 
several persons examined by Mr Abernethy, and re- 
ferred to at page the fifty-fourth of this Essay, it 
was only in some cases the liver was diseased^ 
whereas such a condition occurred in every instance 
in the intestinal canal, and was there of great extent 
and severity. In other instances, alluded to at 
page the forty-seventh of his Observations, there 
existed intense disorganization in the intestines, 
but no mention is made of any unhealthy state of 
the liver. It is more than probable thatDr Black- 
all's five cases (see page the seventy-ninth) were 
all of this character. We are certain one of them 
was so (and in this mercury was administered 
under the idea of liver disease), and we are autho- 



80 NATURE AND SYMPTOMS 

rized to conclude the rest were of the same nature, 
from the exact similarity of their symptoms and 
termination. In Mr Howship's observations on 
disorders of the lower bowels, five cases are re- 
lated, in which abdominal pain and uneasiness, 
anorexia, debility, emaciation, and frequent copious 
stools of bilious, dark, offensive matter, were the 
prominent symptoms. They are correct speci- 
mens of what are now very frequently considered 
liver complaints ; but on dissection, disease was 
ascertained to be confined to the bow r els, the liver 
being unaffected. 

The best continental writers on abdominal 
derangements are unable to embrace the English 
notion of the paramount frequency and importance 
of liver disorder or disease. The laborious ob- 
servations of Broussais, Andral, and others, have 
made them acquainted with the frequency of in- 
testinal lesions; but the liver has comparatively 
seldom been found by them thus invaded. They 
have uniformly been struck with the severe, com- 
plex, and extensive morbid actions, constantly aris- 
ing from gastric and bowel disorder; but they 
have yet to learn, that actions, still more intense 
and complicated, unfailingly attend upon hepatic 
derangement. In this point, I think that the 
French and German practitioners, as a body, are 
superior to us, and the reason is obvious. In their 
practice and researches, they are not misled by 
bilious theories, and notions of the omnipotent 
powers of calomel, and consequently they have not 



OF INDIGESTION. 81 

a 

fallen into those misconceptions which, from the 
present fashionable opinions in England, prevail 
among us.* 

The late Dr James Curry, who, regarding 
almost every patient with "jaundiced eye,'' could 
see little affecting them but liver disease, was in 
the habit of putting his hand to his right side, and 
saying, he was assured there was a very small por- 
tion of liver left there. Some might think it was 
not wise in him to make so frequent a confession of 
this kind, since, if a man could live for years in 
tolerable health (which was his case), with only a 
very small portion of liver, and that probably in a 
state far from healthy, the conclusion generally 
drawn from thence would be in no small degree 
unfavourable to the doctor's opinion, of the supreme 
importance of the healthful actions of this viscus, 
and of the absolute necessity of restoring to the 
free use of calomel in its derangements. How- 
ever, he was totally mistaken in his own case, for 
after death the liver was found to be quite sound ! 
— a circumstance not much in favour of his dis- 
criminating powers. Yet authors are not wanting, 
who speak of the practical success of this physician, 
attributing it to his superior acquaintance with 
hepatic disorders. To me, this success and dis- 
cernment appear equally problematical. I know 
of more than a few who have fallen victims to his 



* A most magnanimous avowal, showing a mind divested of 
prejudice and capable of receiving opinions if well sustained, even 
when these proceed from successful rivals. — Edit. 



82 NATURE AND SYMPTOMS 

practice, but am not informed of any who have 

been restored to health bv its effects.* 

*> 

Dr James Hamilton, Jun. in his very useful ob- 
servations on the use and abuse of mercury, observes, 
" As it is the object of the author to improve the 
science of medicine, and not to expose the errors 
of individuals who practice it, he avoids mention- 
ing many instances which have fallen under his 
observation, where patients were pronounced to be 
labouring under an affection of the liver upon the 
most superficial inquiry into the symptoms. One 
old lady, nearly seventy years of age, was actually 
put upon a severe course of mercury by a physi- 
cian, who declared that he felt her liver to be en- 
larged, though the examination was made while 
she lay on her left side in bed, and without re- 
moving her dress, which consisted of a thick flannel 
shift, besides the ordinary linen one. In this case, 
however, the liver proved to be quite sound." I 
have lately seen an instance almost precisely 
similar, and my experience painfully convinces me, 
that the occurrence referred to in the former part 
of this extract is sufficiently common. Dr Hall 
remarks, " I have this day had the opportunity of 
ascertaining, by a careful dissection, that in a case 
of mimosis decolor, long considered a case of 
'liver complaint,' there was no perceptible disease 
of that or any other viscus."f 



* We could here introduce the case of at least one other 
eminent physician who fell a victim to the hepatic prejudices 
entertained by himself and medical advisers. — Edit. 

t Essay on the Mimoses, page 142. 



OP INDIGESTION. 83 

Mr Abernethy and Dr Hamilton, Sen. have 
given to the intestinal canal, their full share of ef- 
fect in the prevailing bilious disorders, and their 
treatment is rationally directed towards obtaining 
healthy secretions from them. They believe, that 
the unhealthy colour of the faeces, and all the pro- 
minent symptoms of indigestion, are intimately 
connected with an unhealthy condition of the ali- 
mentary secretions ; and their mode of cure rests 
upon the principle, that " the state of the bowels 
has an important and remarkable influence over 
that of the stomach, of the internal mouth, of the 
external surface, of the circulation, and of almost 
every organ of the human frame."* How far re- 
moved is this view of the nature of those disorders 
of the general health, now so very prevalent, from 
that commonly taken, in which the liver has an 
unreasonable degree of importance attached to it. 
And how different this principle of cure from that 
too generally acted upon, in which large and re- 
iterated doses of a debilitating, and highly stimu- 
lant mercurial, are resorted to ! — a means, it is con- 
ceived, not very well adapted to restore the im- 
paired energies, and natural secretions of any or- 
gan. 

4. The great number of our countrymen w r ho 

* Hall on diagnosis, first part, page 129. This sensible and 
accurate writer justly observes, " A deranged state of the bowels 
may be deemed the fertile and immediate source of most disor- 
ders of function, and the more remote cause of many organic dis- 
eases." 



84 NATURE AND SYMPTOMS 

annually return from the East and West Indies 
with disorder, or disease, in the biliary organs, and 
the exclusive influence of mercury over the acute 
diseases of India, have likewise operated, in no 
mean degree, as causes in the spread of what may 
very properly be termed the bilious mania. Man 
is prone, especially in medicine, to form erroneous 
associations. Persons returning from India are 
naturally led to talk of the universal nature and 
great fatality of liver diseases in that country, and 
to extol the inestimable value of calomel ; hence, 
they readily imagine every considerable disorder 
of the digestive organs, which they meet with 
among their friends and acquaintances in England, 
to be no other than a liver complaint; and suppose, 
that the medicine from which they have so often 
derived immediate and striking relief under an al- 
most vertical sun, must prove the most suitable 
and powerful remedy also to their friends at home. 
The valetudinary are not seldom prevailed upon 
to receive these crude notions, and to pursue the 
practice to which they directly lead. The indi- 
viduals, giving and receiving this information, for- 
get the vast difference existing between the cli- 
mate of Great Britain and that of India, and are 
ignorant of the powerful impression produced by 
climate, on animal as well as vegetable life. They 
are not aware how widely the ordinary diseases of 
the two countries differ from each other in charac- 
ter ; those of tropical regions being for the most 
part extremely acute, and demanding the prompt 



OF INDIGESTION. 85 

and vigorous employment of very active measures ; 
while those under view, in temperate climates, 
are generally rather chronic than acute, indicating 
no immediate danger. This applies especially to 
the biliary organs. Reiterated experience evinces, 
that those who reside within the tropics bear and 
sometimes, indeed, require much larger doses of 
mercury than can be administered with safety to 
those, who inhabit cold or temperate latitudes ; and 
that much more striking benefit attaches to so free 
a use of it in the diseases of the former, than can 
be obtained from the most judicious administration 
of it in those of the latter. The blue pill, which 
we find so valuable at home, is useless in the East 
Indies ; whereas, twenty-grain doses of calomel, 
which no English practitioner would be justified 
in prescribing, unless in urgent cases, and under 
peculiar circumstances that very rarely occur, are 
often ordered in India, twice, or thrice, or even of- 
tener in the twenty-four hours, and with admirable 
effect*. 



* In the United States, and especially in those states situated 
towards the south and west, a physician often rises in celebrity in 
proportion to the magnitude . of the doses of calomel, which he 
ordinarily prescribes. Notwithstanding the temerity of such a 
practice, the patients often recover from the diseases with which 
they were attacked, and the calomel so skilfully administered 
gets the credit of the cure. Should the patient subsequently 
suffer the horrors of a mercurial fever, and a salivation which per- 
haps causes the palate and gums to slough, and the teeth to become 
loose or even drop out, the chance is that the physician will get 
more praise than censure, since it will be inferred that in all 
probability death would have ensued but for the salivation. 

M 



86 NATURE AND SYMPTOMS 

As an instance of the powerful influence of 
climate, in modifying the operation of remedies, it 
will not be improper to notice the fact, that the 
doses of medicines given in England, excite uni- 
versal astonishment among the faculty in Italy. 
The extract of henbane is usually administered 
among us in doses of five grains, three times a day, 
or oftener ; yet Dr Harrison in a letter to Dr Paris 
observes, that when he gave it in Italy to the ex- 
tent of three grains thrice a day, it produced, in 
two patients, a temporary amaurosis, or loss of 
sight, " which disappeared, and again recurred, on 
the alternate suspension and administration of this 
medicine : and it deserves particular notice, that 
these very patients had been in the habit of taking 
similar doses of the same remedy in England, 
without any unpleasant result. Now, that this 
depended upon an increased susceptibility of the 
patient in the warmer climate, rather than an in- 
creased power in the remedy, is unquestionable, 
since the extract which was administered in Italy 
had been procured from London."* 

5. For several years past, there have been medical 
men of talent and character, both physicians and 
surgeons, who after a residence of some years in the 

From the appearances of some of the living monuments of that 
practice which are by no means rare, we think that they purchas- 
ed existence at a dear rate. Of this much we are certain, that 
the very kind of cases in which calomel in large doses would by 
many be regarded as indispensable, yield to a more rational 
treatment where there is no risk of subsequent danger. — Edit. 
* Paris's Pharmacologia, vol. i. 



OF INDIGESTION. 87 

East and West Indies, have returned to practice in 
their native country. They have had to encounter, 
almost daily, the most formidable affections of the 
liver, and alimentary canal, abroad; and have 
grown much attached to calomel, from its excellent 
and unequalled powers in those diseases. Upon 
returning to England, they have unfortunately con- 
sidered the liver to be the root of the mischief, in 
the greater number of the disorders of this 
country, as well as in those of India, and have 
therefore used calomel with great freedom, in their 
subsequent practice at home ; and, by their writings 
and representations, have prevailed upon a large 
proportion of us to embrace their opinions, and 
adopt their mode of treatment. These opinions and 
the manner of cure have been indefinitely and in- 
judiciously described, and still more vaguely im- 
bibed. In regard to the seat of the evil, what ap- 
plies, in truth, to the alimentary canal, has been 
from plausible, though insufficient reasoning, 
assigned to the liver ; and, in point of treatment, 
that which is suitable, with any force, only to 
acute invasions, has likewise been extended un- 
happily to chronic affections. This is a principal 
cause of bilious disorders, and their remedy, 
calomel, becoming so highly fashionable in this 
country. 

These gentlemen have fallen into the same error 
as their unprofessional brethren from India, in dis- 
regarding the great difference in the two climates, 
and in the effects of remedies uniformly resulting 



88 NATURE AND SYMPTOMS 

therefrom. It is strange and surprising how pro- 
fessional men of ability should imagine, that be- 
cause chronic hepatitis is a prominent disease in the 
East and West Indies, it must be so likewise in 
England. With as much reason might it be sup- 
posed, that pulmonary consumption, which is so 
pre-eminently destructive throughout Europe, is 
also a wide-spreading and fatal complaint within 
the tropics. 

Yellowness of the eyes has often been consider- 
ed a certain sign of diseased liver, and the same 
may be said of a sallow or yellow hue of the com- 
plexion ; but these symptoms are very frequently 
seen, when functional disorder exists in the stomach 
and bowels only. That they are not to be de- 
pended upon, as proofs of positive disease in the 
liver, is certain from such cases having been seen, 
where neither yellowness of the eyes or skin were 
present, — instances of which are related in the 
writings of Dr Farre and Dr Blackall. It ap- 
pears to me, that these symptoms have been too 
hastily supposed to indicate, at least, considerable 
disorder in the biliary organs, with more or less of 
obstruction there ; for where such symptoms were 
observable, dissection has failed, in many instances, 
to discover vestiges of these irregularities, while 
marks of great disorder have been visible in the 
intestines, and appearances of the absorption of bile 
from that canal were decisive. Hence we are led 
to believe, that jaundice and yellowness of the 
eyes are not unfrequently consequences of bowel 



OF INDIGESTION, 89 

derangement, unaccompanied with any alteration in 
the qualities of the bile: — under such circum- 
stances, this fluid is secreted in a healthy state, 
but from an unnatural condition of the bowels, 
they do not effect that change in it which takes 
place in health ; and it would appear, that they are 
moreover so affected as to absorb it from their 
surface, and thus it enters with the chyle into the 
mass of circulating blood.* Dr Scudamore enu- 
merates a general sallowness, or partial stains 
of yellow in the skin, as the occasional symptoms 
of indigestion in the intestinal canal ;f and Dr Hall 
is persuaded, that jaundice, and a continued though 
variable state of sallowness— of yellowness or 
jaundiced hue, very frequently accompanies both 
the acute and chronic form of the disorders of the 
digestive organs.J 

In the Medical Repository for March 1824, 
there are two cases related by Dr Chisholm of 
Canterbury, in which yellowness of the eyes and 
skin, and other symptoms that I consider to denote 
derangement of the digestive tube were prominent 

* It is worthy of observation, however, that this sallowness is 
often owing to a peculiar condition of the cutaneous circulation, 
and is wholly independent of the state of the bile. In many 
Europeans who have been long resident in India, we witness a 
sallowness of this description; and it is a yellowish hue, arising 
from the same cause, which often imparts a distinctive character 
to the yellow fever of the West Indies. Dr Good represents the 
yellowness in this fever to arise from the absorption of bile, but 
it has nothing to do with such a cause. 

f Treatise on Gout, page 85 (4th edition). 

% Essay on the Mimoses, page 78, and 1 16. 



90 NATURE AND SYMPTOMS 

features; during life, they were considered as ex- 
amples of liver disease, and treated accordingly, 
but dissection proved the biliary organs to be per- 
fectly healthy. These cases afford additional and 
unequivocal evidence of the truth of many of the 
opinions advanced in this essay, and as the first 
case is particularly interesting, I have transcribed 
it at length. 

" Richard Sutton, aetatis 25, servant in husband- 
ry, was admitted into the Canterbury Hospital, 
April 18th. This poor fellow was in a very de- 
bilitated state, and could not give any account of 
himself. From a person, however, who accom- 
panied him, I learned that his symptoms were, 
' sickness, inability to retain any thing on the sto- 
mach, very obstinate constipation,' and that he 
had some time before laboured under fever and in- 
flammation. — Habeat quam primum hydrarg : 
subm: gr. x. Extr: hyoscyami gr. v. Inj. enema 
purgans. Pil. hydrarg : gr. v. P. Ipecac : comp. 
gr. x. hora somni. On visiting him next morning, 
I had leisure to make a closer examination. Skin 
of a yellowish green hue, as were the conjunctiva 
(as described by Dr Baillie, in green jaundice). 
Great prostration of strength, and flatness of the 
abdomen. Pulse scarcely perceptible at the wrist. 
No fulness of either hypochondrium. On apply- 
ing pretty severe pressure to the right lobe of the 
liver, he appeared to wince. Urine natural in 
quantity, but rather highly coloured. The calomel 
has procured several dark, offensive stools. Sick- 



OF INDIGESTION. 91 

ness only after eating. Retained the Dover's pow- 
der, which, with the blue pill, is to be continued 
every night. Cathartic mixture every morning, 
and the effervescing mixture occasionally. 

" This plan was persevered in until the 25th, 
during which time I had several opportunities of 
shewing this case to my professional friends, who 
agreed with me in thinking (though the case was 
obscure), that the seat of the disease was the liver. 

"25th. Omitt: Pulv: Ipecac: Co.— Cont Pil: 
Hydrarg: Illin. Semi-drachma Ung. Hydrarg. Fort. 
Sup. reg. Hypochon dextr. quaque nocte. 

" The greatest attention was paid to the different 
symptoms. The bowels became more regular in 
their action, and the dejections more natural ; the 
sickness, too, was less distressing. Nourishing 
food, with wine, was given 5 as well as bark, aro- 
matic confection, &c. &c. The treatment, how- 
ever, was of no avail : he died on the 20th of May. 

"Dissection. — I examined the body 24 hours 
after death, when I found the liver perfectly natu- 
ral in size and structure; the gall bladder about 
one-third full of healthy bile; the stomach smaller, 
and more flabby than common ; no disease of the 
cardia or pylorus ; pancreas, spleen, kidneys, and 
urinary bladder, natural. The intestines had a 
contracted appearance, and their villous coat (as 
did that of the stomach) readily yielded to the ap- 
plication, though slight, of the finger-nail The 
lungs were studded with tubercles in different 
stages, and very firmly attached to the pleura cos- 



92 NATURE AND SYMPTOMS 

talis, on both sides, requiring very great force to 
separate the adhesions. The pericardium con- 
tained about an ounce of fluid, and was here and 
there spotted with coagulable lymph on the inter- 
nal membrane. I thought the heart was smaller 
and softer than natural, but could not discover any 
disease in the mitral, semi-lunar, or tricuspid valves ; 
neither was there any communication between the 
ventricles ; the foramen ovale was closed. On re- 
moving the scull-cap, I was astonished to find the 
vessels, even the most minute, gorged with blood. 
The ventricles contained more fluid than usual, 
and there was evidently a softening of the centri- 
cal and medullary substances." 

This extract would have been perhaps still more 
useful, had the alimentary canal been more mi- 
nutely examined, and the morbid appearances 
there more fully noted ; however, as the descrip- 
tion stands, it proves that the chief disease was in 
that canal, and it is most probable, that all the un- 
healthy phenomena, found in the head and chest, 
derived their origin from the intestinal affection. 
Dr Chisholm considers this " a very vexatious and 
unsatisfactory case ;" but would it have appeared 
so, had liver disease been a less frequent subject of 
consideration with the physician, and the digestive 
tube obtained that attention, which its more deli- 
cate organization, and its more important offices 
demand ? 

This relation proves what I have already ob- 



OF INDIGESTION. 93 

served (page 43), that so far as the colour and 
fetor of the stools are concerned, it matters little 
how healthy the bile is, if the digestive tube is se- 
verely disordered, or diseased ; for we perceive in 
this instance, that the liver was sound, and its se- 
cretion apparently neither faulty nor deficient, for 
the gall-bladder w T as one-third full of healthy bile, 
yet the bowels were obstinately constipated, and 
the motions, produced by the aperients administer- 
ed, dark and offensive. Precisely the same pheno- 
mena have been discovered in other similar cases 
of intestinal disease. 

The second case, alluded to above, was one of 
haemoptysis, which terminated fatally, and where 
the face, during life, " was generally of a cadaver- 
ous hue ; and the conjunctivae much tinged with 
bile." Dr Chisholm observes, " Having heard that 
this patient had been in the hospital (I believe more 
than once) before, and that his complaint had been 
considered an affection of the liver, and treated as 
such, I proceeded to examine that viscus very mi- 
nutely ; its size and structure were natural, but of 
a deeper colour than usual ; the other abdominal 
viscera were likewise healthy." It is evident, 
therefore, that the yellowness of the eyes in this 
patient also, which the physician regarded as de- 
pendant upon hepatic mischief, was really owing 
to functional disorder of the digestive tube. 

A sensation of fluttering at the pit of the sto- 
mach has also been enumerated by Dr Pemberton 
and others, among the signs characteristic of chro- 

N 



94 NATURE AND SYMPTOMS 

nic disease of the liver; but my experience con- 
vinces me, that it is rather a symptom of indiges- 
tion in the stomach or bowels ; and I have known 
Brandishes alkaline solution remove it, after mer- 
cury and other means had been resorted to in vain. 
The same may be said of an intermitting pulse. 
It has been wisely remarked, that " a sense ofjlui- 
tering about the heart, or at the scrobiculus cordis, 
is the universal symptom of disorders of the diges- 
tive organs, and of nervous affections; whilst it sel- 
dom or never occurs in organic diseases.''* And 
that "in organic diseases, the pulse is generally 
frequent and small, but regular. In disorders of 
function, it is usually of the natural size and fre- 
quency, but often intermittent and irregular."f 
From the nature of the symptoms, we cannot be 
surprised if this fluttering and intermittent pulse 
(particularly the latter) should be the cause of 
much uneasiness to the subjects of them, and such 
they almost always are. Therefore, it is gratify- 
ing to be able to dissipate the fears arising from 
this source, by assuring the individuals thus afflict- 
ed, that there are few facts in medicine better 
established, than that these are symptoms of irri- 
tation and disorder, but not of disease. "Some 
books speak of intermitting pulses, as dangerous 
signs, but, I think, without reason ; for such trivial 
causes will occasion them, that they are not worth 

* Hall on Diagnosis, first part, page 105. 
t Ibid (page 125). 



OF INDIGESTION. 95 

regarding in any illness, unless joined with other 
bad signs of more moment."* 

Judging from the frequency with which we 
hear of our neighbours being afflicted with " liver 
complaints" it would seem that this disease is more 
common than even consumption. It is accurately 
calculated, that this affection of the lungs carries 
off prematurely one-fourth of the inhabitants of 
Europe, and that above five thousand persons die 
of it annually, in London alone ! Yet, I appeal to 
any unprejudiced person of respectability, who has 
an extensive acquaintance, and especially to those 
whose custom it has been to mix at Bath, Chelten- 
ham, Brighton, &c. among the valetudinary and 
convalescent visitors to those favorite resorts, wheth- 
er, so far as report goes, disease does not appear 
at least as frequent in the liver, as in the lungs ? 
Notwithstanding, if the bills of mortality be exa- 
mined, it will be found that hundreds of deaths 
from consumption are recorded every quarter, 
whilst there is hardly a trace to be found in them 
t)f those who have died from diseased liver. It is 
acknowledged, that disease of the liver is in gene- 
ral by no means so certainly, or rapidly fatal as 
that of the lungs, and that it not unfrequently ori- 
ginates other complaints, which prove fatal (as 
dropsy), from which cause the hepatic disease is 
not recognized as the original source of all the sub- 
sequent mischief; but if it were half so common 

* Heberden's Commentaries, page 510. 



96 NATURE AND SYMPTOMS 

as is conjectured, there is no doubt we should find 
at least fifty cases of death from this disease noted 
in the quarterly returns of the hills of mortality, 
where there is now in fact no more than one. 

Formerly, disorganization of the liver was rare- 
ly found but in middle-aged and elderly persons ; 
now, it seems to be considered almost as common 
in the young as in the old, and is not unfrequently 
recognized even in children. I am acquainted 
with a physician who has gained great credit with 
a family of some distinction, by curing one of the 
little children of a " liver complaint." Yet Dr 
Baillie remarks, in his work on Morbid Anatomy, 
that this disease is hardly ever met with in a very 
young person ; an opinion that does not admit of 
just contradiction. Notwithstanding, I have known 
several young persons who were pronounced to 
have this fashionable disease, and who rapidly 
emaciated and grew worse under an active course 
of mercury, some of them dying in a state of sali- 
vation ! Who can say that these w r ere cases that 
would not have done w T ell, if a rational and suitable 
mode of treatment had been instituted ? 

It were well, if the idea of the universality of 
bilious and liver disease had been the only error 
in this point, introduced among us from abroad. 
Were this the case, it would have hardly been 
worth the trouble of refutation ; but a practical 
evil has resulted from this error in language,*and 
the active mercurial oxides are improperly re- 
presented to be the sure and only remedies for the 



OF INDIGESTION. 



97 



major part of the prevailing disorders of the diges- 
tive organs. Thus, the constitutions of the in- 
habitants of this island have been, within the last 
twenty years, mercuralized without mercy, and, 
consequently, scrophula, consumption, palsy* and 
indigestion, all diseases of debility, have rapidly 
and greatly multiplied ; and as long as this mineral 
is so freely and indiscriminately administered, they 
will continue to increase both in number and ob- 
stinacy. Not only are " bilious and liver complaints" 
much less frequent than many suppose, but when 
disease has really invaded the structure of the bili- 
ary organ, it is very questionable whether an ac- 
tive use of any mercurial preparation is the best 
treatment that can be adopted. This point we 
shall consider presently. 



* That scrophula and consumption have much increased in 
frequency in Great Britain, within the last thirty years, is 
generally admitted; that it is the case with stomach complaints 
is notorious. The following authentic record of the number of 
deaths from apoplexy and palsy, that occurred in London in the 
four last years of the seventeenth and eighteenth centuries, shows 
how alarmingly these diseases also are increasing upon us. 



Years. 

1696 
1697 
1698 
1699 
1796 
1797 
1798 
1799 



Died of Apoplexy 
and suddenly. 


Died of 
Palsy. 


. . . . 109 . . . 


17 . . . . 


. ... Ill . . 


27 . . . . 


. ... 116 . . 


21 . . . . 


. ... 106 . . 


24 . . . . 


. ... 225 . . 


73 . . . . 


. ... 214 


99 . . . . 


. ... 224 . . 


86 . . . . 


. ... 249 . . 


.105 . . . . 



Total 
Mortality. 

18,638 
20,970 
20,183 
20,795 
19,288 
17,014 
18,155 
18,134 



See Willan's Reports, edited by A. Smith. 



98 



CHAPTER II. 



OF THE DIFFERENT KINDS OF INDIGESTION. 



Indigestion, like most other complaints, differs in 
its seat and character in different patients. There 
are four different kinds of disorders of the diges- 
tive organs, each having its seat principally, if not 
exclusively, in a particular organ, though one spe- 
cies or variety seldom exists, for any length of time, 
without producing an unfavourahle change in the 
neighbouring parts, and therefore, in some degree, 
occasioning the other varieties. Among these 
multiplied affections, we accordingly meet with 
some whose immediate seat is in the stomach; 
others, in which the small intestines are chiefly or 
almost entirely concerned; a third description, 
where a faulty or deficient biliary secretion is the 
principal, if not the sole complaint ; and a fourth, 
in which the large intestines are most affected, the 
derangement existing there being sometimes the 
single cause of much local and general disturbance 
and distress. All these being cases of disorder 
situated in some part of the assimilating apparatus, 
may with propriety be classed under the head of 



OF INDIGESTION. 99 

Indigestion, or Dyspepsia, because their immediate 
tendency is to prevent the regular and perfect di- 
gestion and assimilation of the food. 

In the severer forms of this malady, it is mani- 
festly of no small moment to the patient, or assist- 
ance to the medical attendant, that the kind of af- 
fection present be correctly distinguished, since on 
this foundation alone can the former reasonably 
hope to derive from professional exertion, that ef- 
ficient and gratifying relief which it is, in general, 
so well calculated to afford ; and as it respects the 
physician, it is equally evident that this knowledge 
is not only of consequence to him, but also that it 
must, if his efforts are usually successful, be the 
very first which he must obtain. I shall therefore 
endeavour briefly to point out here, the discriminat- 
ing symptoms of the varieties of indigestion now 
referred to, so far as my leisure and experience 
enable me. 

1. In the first modification, furred tongue, clam- 
my mouth, want of appetite, heart-burn, oppression 
at the pit of the stomach after meals, or sinking 
after a short abstinence, with nausea and rejection 
of food, are generally the most prominent symp- 
toms. The mouth is parched and dry in the 
morning, thirst prevails through the day, and the 
breath is more or less fetid. The bowels are of- 
ten tolerably regular, sometimes quite so, and the 
colour of the motions little changed from a natu- 
ral appearance. In some cases, there is a tendency 
to constipation, although the colour of the faeces 



100 DIFFERENT KINDS 

remains the same as they were when the patient 
was quite well. The drinking of much liquid is 
particularly distressing. There is tenderness on 
pressure, and pain at the pit of the stomach, and 
sometimes towards the leftside. A puffy swelling 
also is occasionally to be felt at the former part, 
and, in protracted and severe cases, soreness may 
exist there, and a burning sensation, more or less 
constant, and extending to the right side. Morbid 
acidity in the stomach is very common, and like- 
wise a simple returning of the food soon after it is 
taken, especially of the dinner meal. The urine, 
in general, soon becomes turbid, and deposits, on 
standing, a yellowish, or yellowish red sediment. 
It is not seldom small in quantity. The complex- 
ion sometimes becomes pale, but is very rarely 
sallow. 

£. When the small intestines (parts of great 
extent and importance) are the organs most affect- 
ed, the tongue is usually furred, although not so 
greatly as in the first variety, and perhaps the fur 
has not so white an appearance. Here the thirst 
is less than in the former modification 5 the mouth 
not so parched or dry ; the appetite not so sensibly 
impaired, nor the breath so much tainted. There 
is little oppression, or sense of sinking at the pit of 
the stomach, except after an immoderate or im- 
proper gratification of the palate, nor is there any 
nausea or vomiting; but the bowels are various- 
ly and much disordered, being either very con- 
fined or too much relaxed. The stools are highly 



OF INDIGESTION. 101 

unnatural and offensive, being either of a light 
brown colour, or green, or dark and black, pitchy, 
and frequently slimy. Occasional or frequent 
diarrhoea is often a troublesome symptom of this 
form of the complaint, and sometimes exists from 
the commencement. As thirst is not urgent, fluids 
are not indulged in, and when they are, they do 
not oppress and injure the individual so greatly as 
when the stomach is principally affected. In the 
first modification, there may be considerable extri- 
cation of gas from the stomach ; in this, the patient 
is annoyed with offensive flatulence in the bowels. 
When pain is present, it is felt in the bowels, most 
commonly in the right side, and about the umbili- 
cus ; and as, where the stomach is the part most 
affected, we have heat and viscid secretion in the 
mouth, so when the disorder exists chieflv in the 
bowels, the heat and irritation is most sensible and 
troublesome at the other extremity of the digestive 
tube, and the patient is often afflicted with piles, 
and sometimes with tenesmus, after a visit to the 
water closet. In general, I think the colour of the 
urine is high, and it deposits a highly coloured red 
sediment. The complexion is pale and sallow, 
sometimes yellow, which last colour often tinges 
the conjunctivae also. 

3. Should the biliary organs be chiefly involved 
in the existing disorder, the prominent symptoms 
are in general pain or uneasiness in the right side, 
constipation of the bowels, unhealthy alvine dis- 
charges, in which the white and dark perhaps pre- 



102 DIFFERENT KINDS 

dominate, a yellow thick fur on the tongue, and a 
high pink coloured turbid urine. The appetite is 
usually more impaired than in the second form, 
but not so much so as in the first. The pulse va- 
ries, in a small degree only, from the healthy stand- 
ard. In this, as well as in the second modification, 
digestion appears to take place with tolerable faci- 
lity and perfection in the stomach ; but indigestion 
occurs below this organ, yet not, I think, to so great 
and uncomfortable a degree as when the bowels 
are more under the influence of disorder than the 
liver. Upon the whole, it may be questioned 
whether the sallowness and jaundiced hue of the 
countenance and eyes are more frequent and visible 
here, than they are in the second form ; but they 
are, in some cases, of a more steady character. In 
cases of some standing, there is generally a palpa- 
ble enlargement and hardness in the right side, 
close to the margin of the ribs. 

4. The true seat of indigestion originating in 
disorder of the large intestines, often remains a long 
time undiscovered, the reason of which appears, to 
me to be the frequency with which the generality 
of dyspeptics labour under some irritation about 
the rectum or anus, such as piles, occasional dis- 
charge of blood, heat and pain there on going to 
stool, &c. When patients complain of these symp- 
toms, professional men usually think they are only 
indications of the existence of disorder in the su- 
perior portions of the canal, which do incidentally 
happen to almost all such patients, and which are 



OF INDIGESTION. 103 

only to be removed by the remedies calculated to re- 
move the chief and original affection. As a general 
opinion, this is no doubt a correct one, but cases of 
dyspepsia not unfrequently occur in which the 
chief seat of all the patient's distressing symptoms 
is in the rectum and colon. These cases may very 
generally be distinguished by the presence of pretty 
constant uneasiness about the anus on going to 
stool, with frequent. discharges of blood; occasional 
pain in the rectum ; obstinate costiveness, which 
nothing but medicine is capable, for any length of 
time, of obviating \ and uncommon flatulence. On 
close examination, it will commonly be found that 
the diameter of the faeces, w T hen consistent, is less 
than usual, and flattened or figured ; and sometimes 
there is a slight prolapsus of the skin of the anus 
on one side. Occasionally the patient labouring 
under this form of the complaint, will be daily 
much annoyed by frequent calls to the water closet, 
which are only partially effectual. The most fre- 
quent cause of this modification of dyspepsia, is the 
existence of a permanent contraction, or stricture 
in the rectum, or lower part of the colon ; but I 
believe an excessive irritability of those parts, un- 
attended with any permanent contraction, does now 
and then exist, and form the real seat of ail the 
distress which is suffered under the general appear- 
ance of indigestion. 

In this last modification of the disorder now 
treated of, I have uniformly observed that the pa- 
tients are greatly distressed with bilious headaches. 



104 DIFFERENT KINDS 

if the bowels are permitted to remain in a confined 
state beyond a certain period. But, if the patient 
is tolerably attentive to his diet, his appetite is uni- 
formly good, and the tongue but little furred ; the 
strength however, is often much impaired, and in 
the advanced periods of the malady, the nervous 
depression and irritability are at certain times ex- 
cessive and peculiarly harassing. 

Amongst the multitude of the complaints under 
view, which we are every year called upon to wit- 
ness and to treat, there will ever be many, in which 
some of the above symptoms will be found, that 
are noticed as denoting a different form of the com- 
plaint, while others may be absent that properly 
belong to them ; yet, according to my observation, 
it but seldom occurs, that the characteristic signs 
do not exist in such number, and with sufficient evi- 
dence, to enable us, upon proper consideration, to 
discover the particular kind of derangement w r hich 
we are requested to prescribe for. In stomach 
disorder, the want of appetite, the oppression after 
eating, and the occasional pain in the epigastric 
region and left side, the very furred white tongue, 
the frequent rejection of food, and the distress oc- 
casioned by drinking freely of liquids, will usually 
point to the seat of disorder pretty distinctly. In 
intestinal irritation, the highly disordered state of 
the bow r els, the unnatural appearance and offensive- 
ness of the motions, the intestinal pain and flatulence, 
the partial wasting and debility, while the appetite 
is good and the tongue but little furred, clearly 






OF INDIGESTION. 105 

show, that the bowels are subject to the most sen- 
sible and greatest disorder. The affection of the 
liver is denoted by the greater degree of pain in the 
right side, up under the ribs, of tenderness on press- 
ure there, which is sometimes attended with en- 
largement and hardness, by the pulse being almost 
unaffected, the urine pink-coloured, and sometimes 
by the whiteness and tenacity of the motions. In 
this last form of the disorder, from the insensibility 
of the organ concerned, the symptoms are often 
obscure, and seldom point with great exactness to 
the nature of the malady. The disorder of the 
large intestines may always be ascertained by 
passing a bougie. 

I have observed that in cases of indigestion de- 
pending on great irritation in the large intestines, 
patients have often an unimpaired appetite and 
relish for food, with a clean tongue, and they will 
also digest their food well, provided they are care- 
ful in respect to the two points of quantity and 
quality ; and this state of the stomach and tongue 
will often be present, when they are greatly harass- 
ed by general nervous depression, and local uneasi- 
ness about the rectum. 

There is seldom much difference in the pulse of 
the various classes of dyspepsia. It is mostly small, 
weak, slower than natural, but regular. Under 
an aggravation of the symptoms it may become 
quicker than natural, and sometimes intermitting. 
If there exists an inflammatory action or tendency, 
it is more or less hard. 



106 DIFFERENT KINDS 

The second form of abdominal derangements 
above noticed, appears to me to be the most com- 
mon, and it is also, in general, the most painful 
and obstinate, — that which is more extensive in its 
effects than any other, and which gives rise to more 
dangerous and intractable diseases. Next to it are 
the disorders of the stomach; then those of the 
liver; and lastly, those of the large intestines. 
The disorders of the biliary organs, notwithstand- 
ing what is generally asserted to the contrary, I am 
constrained, after considerable reflection upon the 
subject, and an impartial and strict examination of 
it, to consider as very inferior to the varieties pre- 
ceding it in the foregoing division, in frequency, 
intensity, and importance. 

In the bowels we recognise the seat of those in- 
ternal disorders of the abdomen, which so generally 
prevail in autumn, and at other seasons of the 
year, and which are, for the most part, readily cured 
by aperients and alteratives. Here especially ori- 
ginate gout, scrophula, tic douloureux, and other 
frequent and painful chronic maladies, which we 
have to combat, at every stage of professional ex- 
ertion; and it is likewise here that those more 
alarming and fatal complaints — acute diarrhoea, 
dysentery, cholera morbus, hydrencephalus, and 
perhaps fever, have their chief and primary seat 
and origin. The organization and offices of the in- 
testines, clearly explain the reason why they are so 
pre-eminently susceptible of irritation and disease, 
and serve at the same time to corroborate the fact. 



OF INDIGESTION. 107 

Their internal surface is of immense extent, and 
exquisite sensibility ; it is an absorbing and secret- 
ing surface of the first importance in the animal 
economy ; since the chymous pulp prepared in the 
stomach from the food, is here converted into chyle, 
absorbed, and carried into the circulating system, 
to nourish, sustain, and invigorate the whole, while 
the gross, innutritious parts are carried downwards 
for the purpose of being expelled. Here are re- 
tained, for a longer or shorter time, the bland and 
nourishing, as well as all the harsh and irritating 
liquids and solids which w r e take in the form of 
food, or medicine, or as a gratification to the palate. 
They are applied immediately to its surface, and 
considering how r unremittingly this is done, both 
in excess of quantity, and without regard to quali- 
ty ; how numerous are its blood-vessels and nerves, 
and therefore how highly sensitive it is, and how 
extensive its connexions ; we may be surprised that 
disorder of the stomach and intestinal canal is. not 
more frequent and inveterate, rather than it is so 
general. Besides, there is no other organ which is 
so much affected by the never ceasing changes and 
vicissitudes in the atmosphere, to which we are 
constantly exposed, and from which we so greatly 
suffer in this climate 5 neither is there any one 
(except the stomach), that so immediately and in- 
tensely participates in mental affections, or irregu- 
lar morbid action of any part of the nervous system. 
Hitherto we have considered only the varieties 
of indigestion arising from the difference of their 



108 DIFFERENT KINDS 

situation, but there is likewise a manifest differ- 
ence in dyspeptic cases founded on the general con- 
dition of the constitution, without any reference 
whatever to the particular seat of affection, and 
which distinction it is at least of as great conse- 
quence to understand, as the varieties already no- 
ticed. 

We meet then, in practice, with two different 
states of the general system in this disease ; one is 
a condition of simple debility, the other is a state 
of debility associated with inflammatory action, or 
a strong tendency thereto. The latter case is de- 
noted by a uniformly dry state of the skin, with 
more or less local pain, a tendency to inflammatory 
congestion in the head, side, lungs, or other parts, 
being frequently present, with a hardness in the 
pulse. There exists also much feverish heat, 
which stimulant remedies are very apt to augment 
greatly. In the former case, the skin it is true is 
sometimes dry, but it is also often moist, and that 
for days or weeks together; and there may like- 
wise be local pain, but it is manifestly rather the 
pain of weakness and disorder than that of inflam- 
mation, and the same may be said of any appearance 
of congestion in the head, &c. The pulse here is 
small and feeble, without any tension ; and the fe- 
verish heat or flushes, which almost all dyspeptics 
are occasionally more or less subject to, is such as is 
generally relieved by mild tonics and stimulants. 

Many cases of indigestion with inflammatory ap- 
pearances occur, which require the exercise of 



OF INDIGESTION. 109 

much caution and discrimination, in order to ascer- 
tain whether these appearances are owing to de- 
bility, or to inflammation, and many grievous er- 
rors have been committed in this respect from 
want of attention.* Yet I think a physician of 
observation can rarely fail to discover the real na- 
ture of the case before him, if he duly considers 
the condition of the pulse and skin, with the con- 
stitutional tendency of the patient, and does not 
overlook the fact that debility alone, when con- 
siderable, will often produce in persons not dis- 
posed to inflammation, such an irregular and ap- 
parently excited state of the local circulation, as 
simulates true inflammatory action. This subject 
will be further illustrated in the fourth chapter. 

The inflammatory action above adverted to is, 
of course, not that of acute inflammation, but of 
an inflammation of a subdued and imperfect char- 
acter, which is usually termed chronic. 

* Some years since, a surgeon at a fashionable watering place 
attended a patient, above fifty years of age, well known to the 
author, who laboured under considerable weakness and much sto- 
machic disorder j and had always been weakly. The surgeon allud- 
ed to was called in to attend her for a great increase of internal 
disorder, accompanied with pain and uneasiness about the fore- 
head and eyes ; the latter symptoms led him to bleed her from 
the arm, and an increase of pain being the consequence, he bled 
her again : the result was lamentable indeed, for it produced so 
much exhaustion that the next day she suddenly lost her sight, 
which has never returned. This was a case in which tonic re- 
medies were indicated, and would probably have done the patient 
much service, whereas the debilitating measures so improperly re- 
sorted to, inflicted an injury from which it is very unlikely she 
will ever recover. 



110 



CHAPTER III. 



OF THE CAUSES OF INDIGESTION. 



Almost every observant person is now struck with 
the frequency of Indigestion among the inhabitants 
of Great Britain, and it is a common and interesting 
question, what is the cause of the uncommon fre- 
quency of this complaint among us ? It is seldom 
that I have met with a correct answer to this en- 
quiry, either in conversation with professional men, 
or in their writings 5 some attribute it to one thing 
and others to another, but most certainly the cause 
is not one, it is not single, but is for the most part 
dependent on changes which have of late years 
gradually taken place in the general pursuits and 
mode of living in this country, and since these 
changes are undisputed, and are, I think, equal to 
the production of the effect, the real sources of the 
malady appear to me sufficiently manifest. 

It is a general sentiment that a grand cause, if 
not the chief one, is inordinate repletion, and its 
necessary concomitants morbid distention of the 
stomach, &c. ;* but many circumstances concur to 

* Some authors on Indigestion appear to lay great stress on 



OF INDIGESTION. Ill 

prove the fallacy of this opinion. It is fully as- 
certained that the old English ate and drank as 
much (some think more, and I am of that opinion) 
as we do in the present day, yet they were com- 
paratively exempt from indigestion. In the reign 
of Henry the eighth, for example, both wine and 
ale were commonly drank at breakfast, the quan- 
tity served being a pint to each person ; and maids 
of honour in the court of Queen Elizabeth ate 
beef steaks for breakfast, and drank ale after it 5 
while at present we can hardly take a small quan- 
tity of ale after dinner, without its occasioning much 
inconvenience. Again, it is well known, that in the 
majority of cases, if a dyspeptic will give ease to 
his mind, and free exercise in the open country 
to his body, he digests his food easily and perfectly, 
which before sat very uneasy on the stomach, and 

morbid distention from over-feeding, as a cause of indigestion, 
and also on eating too fast as a source of morbid distention ; 
but is not this mere trifling, when causes of greater frequency 
and weight are at the same time overlooked? Did not our 
fore-fathers distend their stomachs as much as we do, or more, 
and did they not eat as fast ? Yet where was their indiges- 
tion? This view of the subject, although countenanced by 
some whose writings on this complaint are valuable, is very un- 
satisfactory and erroneous. A knowledge of the causes of a dis- 
ease is of great consequence towards a correct employment of 
the most efficient means of recovery; and this view has a direct 
tendency to lead patients to lay the greatest stress, on what is 
in reality of inferior importance. It cannot be my wish to un- 
dervalue the effects of attention to diet, but, as I have had occa- 
sion to remark elsewhere {Treatise on the Art of Prolonging 
Life), in all sciences we must learn to distinguish the relative value 
of different agents, if we would apply them with the best effects. 



112 CAUSES 

often excited perhaps what are termed fits of dys- 
pepsia. It cannot be correctly said, that in these 
instances the diet is the cause of indigestion. It 
is true it proves the incidental occasion of uncom- 
fortable sensations and disorder, because there pre- 
viously existed a weakened and depraved condi- 
tion of the assimilating organs, from the influence 
of moral or physical causes (or both) of a charac- 
ter very different from excessive repletion ; the sto- 
mach here being rebellious and fastidious, simply 
from its debility, and not because the food is of 
inferior quality, or in improper quantity. 

I consider the principal causes of indigestion to 
be 1st. A sedentary mode of living, that is, one in 
which bodily exercise is deficient ; 2dly. Anxiety 
of mind ; 3dly. The inhabiting populous cities or 
places. Among the chief minor causes we may 
probably reckon, light dressing; late hours; and 
an unrestricted indulgence of the appetite. In 
the latter we may include the influence of impro- 
per quality, as well as undue quantity of food. 

After much consideration of this subject, I am ful- 
ly persuaded that deficient exercise and mental anx- 
iety are by far the most common and most pow- 
erful sources of dyspepsia, and when considered 
in conjunction with the common practice of crowd- 
ing into towns and cities, to the neglect of those 
rural pursuits, which necessarily carry men abroad 
continually into the open country, they will be 
found quite equal to the production of that re- 
markable and general change in the vigour and 



OP INDIGESTION. 113 

energies of the digestive apparatus, which is now so 
conspicuous among us, and which is the immediate 
cause of indigestion, that is, in what the disorder 
essentially consists. It does not consist with my 
present plan to enter at length into this subject, 
and it must suffice for me to remark that it is very 
evident, that individual wealth has accumulated in 
this kingdom within the last thirty or forty years 
beyond all precedent, the acquisition of which has 
been attended (as the history of the world proves 
it ever has been, and ever will be) with unusual 
anxiety, and diminished bodily exercise of a salu- 
tary kind. It is plain that in the present state of 
things, men's minds are too much engaged, and 
their bodies too little, and here lies the root of the 
bodily mischief so much complained of. It must 
not be forgotten, that independently of the anxiety 
attending an eager pursuit of business, the uniform 
result of success is a greater style of living, which 
invariably brings with it an increase of care, and 
multiplies the sources not of enjoyment, but of dis- 
quietude.* So far as deficient exercise is concern- 



* The influence of success in our worldly pursuits here alluded 
to, when become frequent, is much greater than perhaps the ge- 
nerality of men are wont to think it. It works extensively in va- 
rious ways, and produces marvellous changes on the moral and 
physical condition of a people. With this success, the " pride of 
life" increases ; every man is struggling to compete in style with 
his neighbour, and in the struggle, whether successful or not, he 
necessarily exposes himself to numberless anxieties and disqui- 
etudes, which do not cease even with the consummation of his 
wishes, but are too often thereby much augmented. 



114 CAUSES 

ed as a cause in the present case, I have already 
given it as my opinion (in the book just quoted), 
that it is "the debauchery of inaction," and not of 
repletion, that has spread itself so extensively 
throughout this nation, and engendered so alarming 
an increase of dyspepsia, and other chronic mala- 
dies. 

Among the minor causes, no doubt excess in 
eating and drinking has great effect in multiply- 
ing cases of indigestion 5 which effect is augmented 
by the inferior and base quality of many articles 
of diet of general consumption, such as baker's 
bread and brewer's beer. It is not many years 
since it was as common for families to make their 
own bread, and brew their own beer, as it is now 
for them to have these articles from their trades- 
men. My readers will perceive that I do not wish 
to represent these changes as principal causes of 
the present malady, but they are causes, and pro- 
bably have greater effect than is commonly sup- 
posed. It must be recollected that these are articles 
of daily consumption, and therefore, if injurious, 
their deleterious operation, although in the be- 
ginning silent, yet is sure, and annually accumu- 
lating. 

If what is now said be true, it follows that the 
cause of indigestion is not single, but that its ori- 
gin must in general be sought for in many injuri- 
ous habits ; deficient bodily exercise, and mental 



OF INDIGESTION. 115 

anxiety, being those causes which have by far the 
most powerful influence in its production.* 

* The circumstance of the Parisians and inhabitants of French 
towns generally, being less subject to the various forms of dys- 
pepsia (the very name of which is unknown to them), than those 
of the large towns of England and America, furnishes a curious 
subject for enquiry. Are the French more exempt from any 
or all the causes enumerated by our author than the English 
and ourselves ? Let us view some of these separately. To the 
first, namely, a sedentary life and deficiency of bodily exercise, 
the inhabitants of the Gallic towns perhaps plead as guilty as 
the others we have mentioned, if we except their well known 
saltatory propensities, which however are not generally indulg- 
ed by les gens des lettres of different orders. In regard however 
to the second cause, namely, mental anxiety, we certainly think 
ourselves justified in speaking with less hesitation, and disposed 
to join all the world against the declaration of the facetious Yo- 
rick, that if the French have a fault " they are too serious" The 
happy moral constitution with which they are endowed by nature 
enables them to rid themselves almost at pleasure of those cares 
and inquietudes that sink deep into others and poison the foun- 
tains of their health and happiness. Their capacities for social 
intercourse and keen relish for amusement, let this come in what- 
soever form or shape it may, unquestionably tend in a high de- 
gree to diminish one of the most abundant sources of dyspepsia. 
In the French character we observe far less of what our author 
calls by a borrowed expression, the "pride of life," than is appa- 
rent in the English and, unfortunately, but too strongly manifested 
among ourselves. They seem too much disposed for the immedi- 
ate enjoyment of their worldly goods, to hoard them up with 
ceaseless anxiety in the sordid hope of becoming one day richer 
than their neighbours, and able to outvie them in style. 

A view of the considerations, embraced in our author's third di- 
vision of causes, would require much more space than is allotted 
to a marginal note. One of the topics involved, namely, the pe- 
culiarities of French diet, and notions relating to eating and drink- 
ing, would alone furnish matter for a formidable volume, and pos- 
sibly for two or three. We shall therefore dismiss it with the 
remark, that we regard the free use made of animal food in this 
country, together with the despatch and little discrimination ge- 



116 



CHAPTER IV. 



OF THE TREATMENT OF INDIGESTION. 



In adverting to the treatment of this disorder, I 
think it desirable to notice first, the general prin- 
ciples of that treatment, and afterwards, the em- 
ployment of individual remedies. 

It is proper to notice the general principles of 
management first, because they obviously, suppos- 
ing them correct, form the foundation on which 
alone any physician can practice successfully. To 
these principles, when his practice is considerable, 
he finds himself compelled continually to refer, and 
in obstinate or obscure cases, they frequently prove 
as a light to guide him in the darkness that may 
surround the malady of his patient, and thus pre- 
serve him from being led astray by incidental 
symptoms or circumstances of an untoward char- 

nerally manifested in eating, as contributing greatly to multiply 
dyspeptic ailments. This remark we think applies with peculiar 
force to the very young and aged, or such as have passed the mid- 
dle of life. No fact can be more self-evident than that feeble 
powers of digestion require particular attention both to the quality 
and quantity of the food. — Edit. 



OF INDIGESTION, 117 

acter, and likewise from the mazes of error into 
which many fall who have either no principles at 
all, or only those which are erroneous. 

There are two general principles, which are of 
paramount importance and universal application. 
They are, 1st. That the secretions generally are 
to be restored to as healthy a state as possible ; 
2d. That while we are aiming at this, the strength 
of the patient must be maintained and augmented 
also to the utmost. A third general indication I 
shall notice presently. 

It has certainly been too much the practice in 
this complaint, as well as in other chronic mala- 
dies, to overlook or disregard the latter principle, 
while aiming to accomplish the object described 
in the former, from which circumstance many pa- 
tients have necessarily suffered greatly for a time, 
and some permanently, as the mischief done by 
active lowering measures, could never after be per- 
fectly surmounted. At this we cannot be reason- 
ably surprised, because if the physical strength of 
an individual is reduced below a certain point, it 
is often found impossible entirely to recover the 
injury thus inflicted, at least by the use of any 
means within the individual's reach. I think it 
is frequently not sufficiently considered, that this 
disorder has, for the most part, its origin in de- 
bility, and also that local or general weakness 
is a common cause, indeed the chief cause of 
unhealthy and depraved secretions. It follows 
from this, that when lowering; measures are 
Q 



118 TREATMENT 

used, or permitted to operate, although the most 
efficient alterative medicines may at the same time 
be given, the secretions remain unimproved, and 
the patient instead of getting better, grows worse, 
and for this obvious reason, that we are, by having 
recourse to enervating means, strengthening the 
foundation of depraved secretions, which is debili- 
ty, and thereby rendering the most efficacious al- 
teratives of no service whatever. This applies 
equally to a lowering treatment employed only 
for a few days or hours, and to that pursued for 
weeks ; and these circumstances lead me to believe 
that the very general practice among Surgeons, of 
giving a patient a calomel or blue pill at night, and 
a brisk purging draught in the morning, defeats its 
own object of restoring more healthy secretions by 
the weakness which it occasions. In this case, if 
the pill be given, in combination with antimony, 
and without the purgative, it will seldom fail ulti- 
mately to accomplish the object desired, which I 
believe is frequently unattained when purgation is 
connected with it. 

In indigestion, and all chronic maladies, it may 
be safely laid down as a maxim, that the secretions 
will often be restored to a healthy character by 
tonic remedies, simply used as such, while they 
can never be perfectly and permanently improved 
by the most efficient alteratives, w r hether simple or 
combined, which have an enervating effect, that is, 
which are so administered as to have this result. 
In reference to the treatment of the complaints 
alluded to, there is no general principle of greater 



OF INDIGESTION. 119 

importance than this, and it has its foundation in 
the cause of morbid secretions, which are uniform- 
ly either so entirely dependent on debility, or so 
closely associated with it, as was above remarked, 
that to augment this weakness, is necessarily to ag- 
gravate the unhealthy state of the secreting surfa- 
ces. That debility is the fruitful source of de- 
praved secretions* may be inferred from various 
characteristic circumstances, indeed, from the ordi- 
nary symptoms and progress of all chronic diseases. 
Whenever we meet with a weakly man, who per- 
haps may nevertheless not complain of any posi- 
tive indisposition, do we not always find the se- 
cretions much deranged, and often in an exact pro- 
portion to his debility, the condition of the former 
ever varying with that of the latter, so that if the 
strength be increased, the secreting surfaces are im- 
mediately and evidently improved, while they are 
as directly injured by the reduction of the general 
strength? If it be inquired what is the kind of 
habit in which we witness severe and protracted 
ulcerations, or pimples, or swellings, or inordinate 
discharges, and other evidences of a morbid action 
of the secretory vessels, is not the ready answer, — 
in that which is either originally weak, or which 
has become so from the influence of bad habits, or 
deleterious agents ? Again, in susceptible consti- 



* Under the term secretions, I include all the excretions as 
well as those discharges which are by physiologists more strictly 
termed secretions. 



120 ■ TREATMENT 

tutions, where we fear the possible occurrence of 
tubercles or ulceration in the lungs, or of enlarge- 
ment and ulceration of the joints or glands, &c. 
(such as is so frequently seen in strumous habits, 
or those disposed to scrophula), is not the correct 
advice of the physician invariably to this effect — 
if you can maintain the patient's general strength, 
you place her in a state of security, but mark well, 
whatever tends to lower the general vigour of the 
frame will threaten her very existence. The or- 
dinary operation of the most useful remedies con- 
curs to prove the correctness of the assertion now 
advanced, for how frequently does it happen that 
the physician seeks in vain, even by the most pow- 
erful alterative medicines judiciously prescribed, to 
correct the unhealthy condition of the vessels just 
referred to, if he neglects to recommend, at the 
same time, means which have what may be term- 
ed a direct tonic effect. Thus it is that quinine, 
iron, and other tonics, given in conjunction with 
calomel or blue pill, often accomplish such objects 
as are now spoken of, which the latter could not 
do alone, even under favourable circumstances in 
other points of view.* 

* For the same reason the professional man appears to me of- 
ten to defeat his own intentions, when he advises in chronic dis- 
orders the use of mercurial alteratives, for example, but likewise 
recommends at the same time local, or general blood-letting. In 
this way, he is frequently employing, in the same day, antagonist 
forces, and may be seen really, though unwittingly, creating great- 
er disturbance than he was called to cure. 



OF INDIGESTION. 121 

These facts show the utter folly of a sentiment 
common among a certain class of persons, that in 
severe chronic diseases, the constitution must in 
the beginning suffer under the operation of active 
remedies, in order to the cure of the existing ma- 
lady. This is a sentiment which has been the 
source of innumerable evils, and whether express- 
ed in words, or only by the practice of those who 
embrace it, ought never to meet with any quarter. 
It points to a way the very reverse of that dictated 
by Nature, and therefore the reverse of what is 
right, for the moment she commences the cure of 
any disease, in the same moment does she begin to 
restore a comfortable feeling to the afflicted, which, 
in the main, increases and keeps pace with his grad- 
ual recovery. 

A third grand indication in the general manage- 
ment of disorders of the digestive functions, is the 
relief of irritation. Keeping this principle in view, 
may assist us very much in the correct application 
of the other principles just noticed, for if the mea- 
sures taken to restore healthy secretions, or aug- 
ment the strength, are productive of irritating or 
uncomfortable sensations, we may almost always 
conclude that those means are either inappropriate 
in themselves, or employed in an unsuitable manner. 
The results of attention to it likewise tends greatly 
to strengthen the evidence in favor of the senti- 
ments here advanced, respecting the necessity of 
increasing the general energies of the body as far 
as possible, for we invariably find that irritability. 



122 TREATMENT 

pain, and irritation are closely connected with de- 
bility, so much so, that whatever augments the lat- 
ter aggravates the former, and, on the contrary, 
we cannot take a more certain way of lessening 
the former, than by resorting to those means 
which have the greatest influence in removing the 
latter.* 

Acting on this principle of relieving irritation 
to the utmost is also very frequently of eminent 
service in directing us to such measures, as prove 
of great value in aggravated cases, which, at least 
in the beginning, do not admit of remedies tend- 
ing directly either to improve the secretions, or in- 
crease the strength. It must be remembered that 
I now advert to protracted or extreme cases, in 
which we so commonly find excessive uneasiness 
and irritation, under various forms; and in which 
we are unable, with propriety, to do more than en- 
deavour to soothe the malady of the sick, until a 
favourable change takes place, and permits us to 
advise measures capable of exercising a beneficial 
influence of a positive character. Here we have it 
always in our power to recommend the use of mild 
soothing means, calculated to relieve irritation, and 



* Indeed, we may take an extended view of the subject, and 
justly affirm that, as Mr Abernethy expresses it, the relief of irri- 
tation is the great object of medicine. For in proportion as we 
succeed in delivering our patient from all that is debilitating and 
annoying, so do we enable the constitution, or Nature, as some 
would say, to perfect the work of restoration. This sentiment is 
equally applicable to acute and chronic diseases. 



OF INDIGESTION. 123 

thus to pave the way for the more speedy and more 
effectual application of remedies designed to fulfil 
the preceding indications, and thereby permanently 
to restore the patient's health. 

We have now to speak of the application of indi- 
vidual remedies to the fulfilment of the general 
principles or indications above proposed, and this 
will terminate what I have to say respecting the treat- 
ment of the present disorder, for in proportion as 
we succeed in allaying irritation, and in establishing 
the physical energies of our patient, and improving 
his secretions, so do we succeed in restoring him to 
health. 

The remedies for indigestion naturally divide 
themselves into three great classes, viz : — Medi- 
cine, Diet and Regimen. Under the head of Regi- 
j men, I include air, exercise, bathing, and the like. 
The medicines which I have found to possess 
the greatest efficacy in fulfilling the objects just 
noticed, as being those which we should ever chief- 
ly keep in view in the treatment of the present 
complaint, are mercurial preparations, rhubarb, ipe- 
cacuan, nitric acid, the alkaline solution, and cer- 
tain metallic oxides, with quinine, sarsaparilla, and 
mild aperient medicine. 

In the treatment both of the slighter and more 
severe disorders of the digestive organs, at this 
time so prevalent in every part of Great Britain, 
mercury, in general practice, holds the first place, 
and certainly its administration is very often at- 
tended with admirable effects, and sometimes such 



1 24 TREATMENT 

as cannot be obtained by any other known remedy. 
But though frequently an eligible medicine, it is 
not always the best, even in small quantities ; and 
has certainly been injurious in the common way 
of administering it, which I consider injudicious in 
regard to the mode, and deleterious in point of dose 
and repetition. 

Calomel is, on the whole, the favorite form of 
this mineral, but as it has a strong tendency, when 
given alone, to weaken and irritate the stomach 
and bowels, it ought always in chronic diseases to 
be conjoined with other alteratives, which are of 
milder operation, and capable of aiding its salutary 
effects. Therefore, the frequent practice of order- 
ing a grain or two of calomel alone in a pill at 
night, with an aperient in the morning, cannot be 
too severely reprobated. The proper practice is 
to combine it with tartarized antimony or James's 
powder, and guiacum, with or without a minute 
dose of opium, as circumstances indicate.* 

In many cases, the milder preparations of quick- 



* The following formula for alterative pills may be convenient 
to some, disposed to try the practice here recommended. 

Take of calomel, twenty grains; tartar emetic, four grains; 
pulverized gum guiacum, two scruples. Rub these intimately to- 
gether in a mortar, and with the addition of a sufficient quantity 
of conserve of roses, or syrup of any kind, form into a mass and 
divide into twenty pills. 

The above prescription may be advantageously varied on some 
occasions by leaving out the tartar emetic and substituting twenty 
grains of James's powder. It is also sometimes useful to combine 
with the mass a small portion, say two or three grains of opium or 
its extract. — Edit, 



OF INDIGESTION. 125 

silver, as the blue pill, or hydrargyrus cum creta^ 
being less irritating than calomel, are found to agree 
much better, and to be very useful when the latter 
fails of any beneficial effect. This appears to take 
place chiefly when great debility is present, or the 
system is unusually irritable. I believe, however, 
that in numerous severe examples, the combina- 
tion of calomel and antimony above referred to, 
excites a greater curative power than the blue pill, 
or any other mercurial compound. 

Since all mercurial preparations are very active, 
the subjects of dose and repetition are worthy of 
great regard, and this applies more especially to 
calomel, because it is the most energetic of those 
preparations in ordinary use, and also from the 
doses in which it is too commonly given, being, in 
my opinion, improperly large, and more likely to 
produce and increase disorder than to remove it. 

Some cautious practitioners look upon any quan- 
tity of calomel above four grains to be large ; but 
I think the same of half that dose. Three, four, 
five grains, and even more, once or twice a day, 
for days or weeks, are doses now frequently order- 
ed,* when half a grain at bed time, or a grain three 
or four times a week, where this article agrees, 
will effectually promote healthy secretions in some 
very bad states of the assimilating viscera. Then, 

* Since the publication of the former edition of this book, I 
have had reason to hope that this medicine is not now given so 
incautiously as formerly ; the above remarks, however, appear to 
me still quite appropriate. 
R 



128 TREATMENT 

surely, fifteen or twenty times that quantity of a 
substance which operates as a powerful stimulant 
to all the digestive organs, and to every part of the 
body, cannot fail to be extremely injurious. For- 
merly, a grain or two of calomel taken occasionally 
was considered sufficient to accomplish the ends for 
which, quantities, so excessive, are now recom- 
mended for a long continuance. This unhappy 
increase has arisen from a common and natural er- 
ror, that of expecting an increased advantage from 
an augmented dose ; it being either overlooked, or 
disregarded, that all medicinal substances are, for 
the most part, only relative agents in the cure of 
disease, and that it is the dose which almost inva- 
riably determines their specific effect; so that, 
though half a grain, or a grain of calomel, carefully 
repeated, is often powerfully curative, three, four, 
and more grains, administered at the same or short- 
er intervals, may be, and actually is, under ordinary 
circumstances, truly poisonous.* 

Perhaps it will be urged, that though a grain, or 



* It appears to us that the effects of no two medicines, having 
the least resemblance to each other, can differ more than those of 
calomel when given in large and in small doses. In a large dose, 
its operation is for the most part limited to the alimentary canal, 
where it acts as a prompt evacuantj but when administered in 
minute and often repeated doses, its chief impression is made up- 
on other tissues than those with which it comes first in contact, 
and a general irritation is roused throughout the system, which 
frequently proceeds to inflammation in the fibrous, cutaneous and 
glandular structures. Such a distinction we think of the highest 
importance in a practical view. — Edit, 



OF INDIGESTION, 127 

half a grain of calomel, administered three or four 
times a week, will correct some bad disorders of 
the abdominal viscera, it requires much more ac- 
tive doses, or at least that the grain should be fre- 
quently repeated, and longer continued, to remove 
a true liver complaint, that is, positive disease there. 
But this assertion is contrary to daily experience, 
and opposed to the opinions of some of the most 
esteemed practitioners of the present day. I have 
seen the constitutions of such persons irrecoverably 
ruined by active mercurial courses ; but, in no in- 
stance, did I ever witness a cure effected by this 
treatment. It is painful to recollect, that in dis- 
organized livers, mercury carried to the extent of 
salivation is commonly regarded as the sheet an- 
chor, the fit and only remedy ; for I will venture 
to affirm, that the far greater number of such cases 
grow materially worse, rather than better, from 
such use of it; and that this aggravation consists 
not merely in an increase of the patient's weakness 
and morbid irritability; but that the existing dis- 
ease in the liver becomes more extensive and inve- 
terate. Among others, Mr Abernethy, Dr Black- 
all, Dr Farre and Dr James Hamilton, Jun., bear 
a strong and weighty testimony against salivation 
under such circumstances, w T hich it is highly desi- 
rable should be universally attended to.* 

* If the opinions here set forth with so much force be correct, 
and that they are so we have not the least doubt, what incalcula- 
ble mischief must result from a practice, founded upon the com- 
mon notion of the absolute necessity of a mercurial salivation for 



128 TREATMENT 

The first of these able writers observes, "Per- 
sons who are salivated have, as far as I have re- 
marked, the functions of the liver and digestive or- 
gans constantly disturbed by that process. I can- 
not, therefore, but think that it is wrong to use 
mercury in hepatic affections to that extent which 
would disorder the functions of the liver, if they 
were previously healthy. In the majority of cases, 
the disorder has existed for a long time, and has be- 
come habitual ; therefore it is not likely to be cur- 
ed suddenly. For this reason, we should adapt 
our treatment to the more rational expectation of 
effecting a gradual recovery, than a sudden cure."* 

Dr. Blackall's general habits of discrimination 
entitle his sentiments, on a question like the pre- 
sent, to considerable attention. In speaking of 
mercury, he says, " On the scirrhus or tuberculated 
state of the liver, a frequent cause of dropsy in this 
country, I have seldom seen it make any impress- 
ion. It would be somewhat in its favour to add, 
that it is universally safe. I dare not assert this, 
since I have seen, in such instances, the mercurial 
habit superadded by continued salivation, and then 
the disorder become more complicated and more 
speedily fatal."! 

DrFarre, when treating of chronic enlargements 
of the liver, observes, "Patients suffering under the 

the cure of what may be properly or improperly named liver com- 
plaints — Edit. 

* Surgical Observations, before cited, page 77. 

t Observations on Dropsies, page 70. 



OF INDIGESTION. 129 

diseases above described, are not, as far as I have 
observed, benefited by the operation of mercury. 
Few medical men now attempt to cure, by these 
means, tumours, in the restricted sense of the word, 
at or near the surface of the body ; but it is more 
especially true, that such efforts prove altogether 
fruitless, when directed to the cure either of the 
tubera circumscripta, or diffusa ; for by the time 
that the most careful examiner can distinguish them, 
the progress of the disease has been already so con- 
siderable, that the mercurial action tends only to 
exhaust powers, which art will subsequently in 
vain attempt to restore."* 

Dr James Hamilton, Jun., also, has remarked it 
to be his experience, that " the ordinary mode of 
exhibiting mercury for the cure of chronic hepati- 
tis, in this country, not unfrequently hurries on 
the disease, or, by impairing the constitution, lays 
the foundation for paralytic affections ; and it may 
be truly affirmed, that it thus often shortens life."f 

There are even some Indian practitioners of re- 
putation, who, desirous of keeping in view the great 
difference existing between acute and chronic disease 
of the liver, have objected to the free use of mer- 
cury in the latter, though none are more sensible 
of its superior efficacy in the former state of disease. 
Dr Dick, whom Dr Saunders calls "a gentleman 
high in the medical profession, in Bengal, and of 

* Morbid anatomy of the Liver, page 21. 

t Observations on the Use and Abuse of Mercury, page 79. 



130 TREATMENT 

much practice in Calcutta," says, " In recent attacks 
of liver complaints, after early bleeding, blistering, 
and the free use of laxatives, I never saw a case 
where suppuration came on, if mercury were free- 
ly used, and continued till the mouth was sore ; 
and, if I be not much mistaken, it is in such cases 
that it has the best effects. In chronic cases, there 
is no fever, but only an obtuse pain in the side and 
shoulder, with a fulness in the side, and about the 
pit of the stomach, keeping up a constant uneasi- 
ness, mercury seems to me to have but little good 
effects ; when used freely, it removes the symp- 
toms at the time, but they generally return as soon 
as the mercury is left off."* 

Where an alteration exists in the structure of 
the liver, it appears to me, that if mercury is capa- 
ble of making any impression on the disease, it is 
when exhibited in small doses, at distant intervals. 
If a four-grain compound calomel pill, or five or 
six grains of the blue pill, given every night for 
some time, is not able to reach the complaint, 
this mineral will generally be ineffectual, and in 
augmenting the quantity till salivation is induced, 
we shall only be distressing and weakening the pa- 
tient, without at all gaining upon his disease. Per- 
sons, in such a case, derive real advantage only 
from small undebilitating doses of mercury, that 
do not very sensibly affect the general system ; and 
not from active, enervating courses, which disturb 

* Saunders on the Liver. 



OF INDIGESTION. 131 

every healthy process. " Though mercury be a 
remedy of signal benefit in altering the condition of 
action in the extreme vessels, it requires a very 
cautious and circumspect management. It re- 
quires to be slowly and gradually introduced into 
the system if of the foundation of change, and the 
renewal of structure, depend upon a gradual, uni- 
form, and extensive action upon diseased parts ; ac- 
tion, violent, irregular, and partial, deranges gene- 
ral health, but does not ordinarily affect the seat of 
the disease"* 

Having considered it my duty, in the former 
part of this essay, to controvert some of Dr Ayre's 
opinions on the pathology of the prevailing " bilious" 
disorders, it is with pleasure I remark, that his ob- 
scured pathological views do not lead to error in 
his practice; for no one can administer calomel 
more judiciously than he does. He condemns its 
use as an active purgative, and considers that one 
grain, or less, in twenty-four hours, is sufficient in 
ordinary cases ; and therefore I may now quote his 
authority in support of the rules here laid down for 
the cautious exhibition of that medicine. 

Mercury must be considered an admirable me- 
dicine on very many occasions; it has enjoyed the 
confidence of the profession above three hundred 
years, and Mr Pearson has justly remarked, that 
"not one medicine besides, derived from the ani- 



* Jackson's Outline of the History and Cure of Fever, page 
314. (1798.) 



132 TREATMENT 

mal, vegetable, or mineral kingdoms, has maintain- 
ed its credit with men, actually employed in ex- 
tensive practice,during a tenth part of that period ;" 
which is a sufficient proof of its value. But the 
remarkable efficacy of this mineral in some cases 
has led to its abuse ; and this abuse seems to me so 
general, and is ordinarily followed by effects so 
permanent and destructive, as to call aloud for cor- 
rection. \ Indeed, it may with propriety be ques- 
tioned, whether mercury, notwithstanding its val- 
uable curative powers, has not been a source of 
more real injury to the constitution of Englishmen, 
than it has, or can be for years to come, of good. 
When I recall to recollection the numerous cases 
of ruined health, from the excessive employment 
of calomel, that has come to my knowledge ; and 
reflect upon the additional proofs of its ruinous 
operation, which are still daily presenting them- 
selves ; I cannot forbear regarding it, as commonly ex- 
hibited, as a minute instrument of mighty mischief, 
which, instead of conveying health and strength 
to the diseased and enervated, is made to scatter 
widely the seeds of debility and disease of the 
worst kind, among persons of every age and condi- 
tion. 

Perhaps it is not exceeding the truth to say that 
the mercurial oxides, especially calomel, are now 
daily given for the cure of disorders and diseases of 
every character, at every stage, and under every 
variety of circumstances ; and, what is fraught with 
the weightiest evil, without care or discrimination. 






OF INDIGESTION. 133 

It is not only the learned physician, or the well- 
educated apothecary, that is so extravagantly 
fond of this substance ; but if the surgeon's dispen- 
ser, or apprentice boy, is called upon to take or to 
prescribe medicine, it is calomel ; if the country- 
man wants physic, he, w r ho formerly found jalap 
or salts to answer his purpose well, must now have 
calomel ; if the delicate young lady needs a pill, 
she sends for blue pill or calomel; — and mothers, 
whether high or low, rich or poor, think nothing 
so good for their infants, as calomel, w r hich they 
pour in with as little consideration as rhubarb or 
magnesia !* 

That so powerful an article, taken or adminis- 
tered by all descriptions of persons, without care 
or discrimination, as to the dose or disease, must 
be attended with the mdst lamentable consequen- 
ces, no one can w 7 ith truth deny ; for this medicine 
is not only a poison in excessive doses, but, as was 

* Dr Blackall, of Exeter, also expresses himself very strongly 
on this subject. "Parents," says he, "have something to regret, 
who are so perpetually giving calomel to their children, without 
any distinction or care, as a common domestic remedy. And 
it is difficult to conceive on what view of the subject even prac- 
titioners proceed, who indulge in its use with less scruple than 
ever, with less attention as to dose, with less caution as to man- 
agement, whilst they are observing and lamenting the daily in- 

i creasing ravages of hereditary scrophulous disorders. It can 
hardly be, in the present day, from want of calomel, that such a 

. taint is propagated." Indeed, the powerful and depressing effects 
of calomel on the whole nervous and vascular systems, unequivo- 
cally prove its poisonous qualities, and raise insuperable objections 
to its frequent employment in free doses. 



134 TREATMENT 

remarked above, even in the ordinary doses of 
two and three grains, it is an active stimulant to 
the organs of digestion, and to the whole constitu- 
tion. There is not another article in the materia 
medica, in common use, which, so immediately 
and permanently, and to so great a degree, debili- 
tates the stomach and bow T els, as calomel ; yet this 
is the medicine which is sent for, and prescribed 
on every occasion ; the most trifling, as well as the 
most urgent ! 

Its action on the nervous system is demonstra- 
tive of its being an article in its nature, inimical to 
the human constitution : since what medicine be- 
sides, in frequent use, will excite feelings so hor- 
rible and indescribable as calomel, and other 
preparations of mercury. An excessively peevish, 
irritable, and despondent state of mind, is a well- 
known consequence of a single dose of this sub- 
stance. Dr Falconer, of Bath, in a paper where 
he forcibly animadverts on its abuse, observes, 
" Among other ill effects, it tends to produce tre- 
mors, paralysis, and not unfrequently incurable 
mania. I have myself seen repeatedly, from this 
cause, a kind of approximation to these maladies, 
that embittered life to such a degree, with a 
shocking depression of spirits, and other nervous 
agitations with which it was accompanied, as to 
make it more than commonly probable, that many 
of the suicides which disgrace our country, were 



OF INDIGESTION. 135 

occasioned by the intolerable feelings that result 
from such a state of the nervous system."* 

To set the poisonous qualities of mercury in a 
still clearer light, I would here insert an extract 
from Dr Hamilton's work on the abuse of mercu- 
ry, and also from Dr Alley's observations on the 
hydrargyria, an eruptive disease which is some- 
times produced by this mineral. The former 
gentleman says (page 24), " In a lady (whom the 
author attended some years ago, along with his 
intelligent friend Dr Farquharson), who had had 
such small doses of the blue pill, combined with 
opium, for three nights successively, that the whole 
quantity amounted to no more than five grains of 
the mass ; salivation began on the fifth day, and 
notwithstanding every attention, the tongue and 
gums became swelled to an enormous degree; 
bleeding ulcers of the mouth and fauces took 
place, and such excessive irritability and debility 
followed, that for nearlv a whole month her life 
was in the utmost jeopardy." Dr Alley observes 
(page 40), that he has seen the mercurial eruption 
appear over the entire body of a boy about seven 
years old, for whom but three grains of calomel 
had been prescribed, ineffectually, as a purgative. 

Some may think, that these instances prove only 
idiosyncrasy in the individuals affected, rendering 
them in an extraordinary degree obnoxious to the 

* Transactions of the Medical Society of London, vol. i. page 
110. 



136 TREATMENT 

pernicious effects of this single substance; that 
such peculiar dispositions, in respect of a variety 
of really innocent medicines, are every day met 
with; and, therefore, that the conclusions here 
drawn, touching the deleterious properties of mer- 
cury, are inconclusive. But this cannot be consis- 
tently affirmed, because the above instances of the 
poisonous operation of mercury are not, like the 
others alluded to, of rare occurrence ; on the con- 
trary, they are common, and are only two out of 
a vast number (not all equally bad) that have 
been, and are still daily witnessed, many of which 
are on record. 

Dr Hamilton, Jun. observes, "In several cases, 
the author has decidedly ascertained, that ulcera- 
tions of the villous coat of the intestines of infants 
and young children have been induced by the 
frequent repetitions of doses of calomel." Does 
not this fact call upon the mother to abandon its 
use altogether in the disorders of her child, and to 
leave the administration of so dangerous a sub- 
stance to the medical practitioner alone? And 
does it not demand more care and attention on our 
part, in prescribing this oxide, than has been of 
late observed? 

There is a circumstance in the operation of 
mercury, which has hitherto been only hinted at 
in these sheets, but which is of no small moment, 
and ought to engage the serious and attentive con- 
sideration of the profession, as well as of all unpro- 
fessional persons, who are in the habit of taking 



OF INDIGESTION. 137 

mercury themselves, or of giving it to their chil- 
dren, — I mean the permanency of its deleterious 
effects. An improper or excessive use of the ge- 
nerality of medicines is recovered from without 
difficulty ; but it is not so when the same error is 
fallen into with the mercurial oxides. They affect 
the human constitution in a peculiar manner, tak- 
ing, so to speak, an iron grasp of all its systems, 
and penetrating even to the bones, when incau- 
tiously employed, by which they not only change 
the healthy action of its vessels, and general struc- 
ture, but greatly impair and destroy its energies ; 
so that their abuse is very rarely overcome. 
When the tone of the stomach, intestines, or ner- 
vous system generally, has been once injured by 
this mineral, according to my experience, and I 
have paid considerable attention to the subject, it 
could afterwards seldom be restored. I have seen 
many persons to whom it has been largely given 
for the removal of different complaints, who, be- 
fore they took it, knew what indigestion and ner- 
vous depression meant, only by the description of 
others ; but since they have become experimentally 
acquainted with both, for they now constantly 
complain of weakness and irritability of the diges- 
tive organs, of frequent lowness of spirits, and im- 
paired strength; of all which, it appears to me, 
they will ever be sensible. Instances of this de- 
scription abound. Many of the victims to the 
practice are aware of this origin of their permanent 
indisposition, and many more, who are at present 



138 TREATMENT 

unconscious of it, might here find, upon investiga- 
tion, a sufficient cause for their sleepless nights, and 
miserable days. 

It is to be lamented, that in our day, in severe 
cases, whether of disordered function, or actual 
disease, which resist the usual remedies prescribed 
under clear indications, salivation is frequently re- 
sorted to from some vague notion of its exerting 
an admirable, though inexplicable effect, when 
previous expedients fail ; and thus, we have often 
every benevolent feeling of the mind called into 
painful exercise, upon viewing patients already ex- 
hausted by protracted illness, and whose only 
chance of recovery depended upon great care, and 
a soothing tonic plan of treatment, groaning under 
the accumulated miseries of an active course of 
mercury, and by this for ever deprived of perfect 
restoration. A barbarous practice, the inconsist- 
ency, folly, and injury of w T hich, no words can suf- 
ficiently describe. I will venture to affirm that 
the man, who undergoes strong salivation in a 
chronic complaint, is never the same person, as to 
strength and bodily feelings, after it, as he was be- 
fore*. 

Let it not be thought that I am insensible to the 
value of calomel, and other mercurial preparations, 

* Except in cases of syphilis, to talk of the cure of a chronic 
disease by salivation would be approaching to the absurd ; but it 
is proper for me to remark, that it is quite diiferent if it be exci- 
ted to check an acute disease, especially in warm climates ; here 
it is often the only and the effectual remedy. 



OF INDIGESTION. 139 

or that it is my desire to undervalue them. By 
no means. I have already said sufficient respect- 
ing them, to prove the contrary ; but it is too often 
forgotten in medical practice, that they are of a 
nature unfriendly to our bodies, which is a well 
established fact ; and is, therefore, singly a proof 
that they ought to be exhibited sparingly, and with 
great caution. So far from being adapted to do- 
mestic use, calomel is a medicine which an unpro- 
fessional person should never presume to touch on 
his own opinion. When administered with care 
and judgment, it is sometimes invaluable, being 
capable of accomplishing the most desirable pur- 
poses ; but in the hands of the uneducated and un- 
skilful, it becomes a deadly weapon. 

The combinations of mercury which my obser- 
vation leads me to regard as most useful in indiges- 
tion, are calomel, with tartarized antimony or 
James's powder, guaiacum, and opium ; or the 
blue pill, with James's powder, or the compound 
powder of ipecacuanha. A small pill of this de- 
scription may be given every night, or every other 
night, in conjunction with any other medicine, 
excepting the mineral acids. 

Rhubarb and ipecacuanha are both of great ser- 
vice in this complaint, especially in stomach affec- 
tions, or where the biliary secretion is faulty or 
deficient. They are most efficacious stomachics 
and aperients, and have appeared to me to render 
altogether unnecessary any of the ordinary bitters 
and aromatics, as gentian, cascarilla, &c. in the 



140 TREATMENT 

treatment of the great majority of the disorders of 
the assimilating organs. Rhubarh is inferior only 
to mercury in its power of changing to a natural 
colour, the very discoloured evacuations so com- 
mon to such disorders — a change which is always 
considered most desirable. If it is not alone equal 
to this effect, a small dose of ipecacuanha, or tar- 
tarized antimony, added to it, will rarely fail so to 
increase the efficiency of the rhubarb, as to render 
it fully effectual. The value of this drug as a 
stomachic, and corrector of unhealthy motions, is 
not sufficiently known and appreciated. Mercury 
will often disappoint our expectations in the chro- 
nic affections of the liver and duodenum, in this 
country, when rhubarb is perfectly successful ; the 
reason of which seems to be, that we often require 
a medicine, which combines a tonic or stomachic 
property, with that of exerting a direct salutary 
action on the dqpdenum, and the biliary ducts 
which terminate in it. Now mercury possesses 
only the latter power; but rhubarb unites the two. 
It has been judiciously observed, that as " when a 
disordered state of the stomach is induced by the 
bile" (a circumstance seldom occurring), " no bit- 
ters will be useful ; so, if an unhealthy condition 
of the bile is induced by the stomach, no blue pill 
will avail 5"* but we then order such bitters as 
rhubarb with great effect. 

* Abernethy : — Manuscript of Lectures delivered at Bartholo- 
mew's Hospital. 



! 



OF INDIGESTION. 141 

If the virtues of rhubarb were duly prized, cal- 
omel and the blue pill would be in less use in the 
bilious disorders (as they are called), both of 
adults and infants. In the intestinal irritations to 
which the latter are subject, it is undoubtedly far 
superior to calomel as a common remedy. The 
frequency of bowel complaints, among young chil- 
dren, is evidently connected with the weakness of 
the intestinal canal at their early age ;* there is 
then a deficiency of that tone of energy in the 
bowels, which, in persons of mature years, pre- 
vents the matters received into them from so soon 
suffering decomposition, and forming new and vi- 
cious combinations that irritate and disorder. 
Therefore, we might reasonably suppose, that a 
medicine which readily promotes a healthy flow 
of bile, and strengthens at the same time that it 
evacuates, would be much better suited to the ten- 
der organs of a child than calomel, which, though 
often a valuable remedy, is of a very debilitating, 
enervating nature. It has frequently been assert- 
ed, that children require large doses of calomel, 

* A sentiment, quite opposite to this, has prevailed too much 
among some medical men ; but the opinions of Magendre has 
every support that can be desired from reason, observation and 
experiment ; and now that we see active mercurials so constantly 
and fearlessly given to infants, it may not be without effect to 
quote his words. " Instead," he says, " of considering the diges- 
tive organs of a new-born child, or even those of one very young, 
as being gifted with an overplus of strength, we must view them 
as much weaker than they will thence forward become." 

Magendie's Physiology, vol. ii. p. 117. 



1 42 TREATMENT 

and bear them better than adults, which appears to 
me an erroneous and dangerous sentiment. The 
mucus and slime, that so thickly line their intes- 
tines, may frequently render a moderate dose, or 
doses, ineffectual, if uncombined with any other 
aperient ; but those who, on this account, augment 
the quantity, and repeat it, until it operates power- 
fully, pursue, to say the least, an unsafe and inju- 
dicious practice. I repeat it, that there is no truth 
in the practice of medicine more apparent and cer- 
tain, than that the exhibition of large and repeated 
doses of mercury, for the cure of chronic maladies, 
is highly inimical to the constitution of all persons: 
they ought, therefore, to be carefully avoided. 
None but cases of emergency justify their use in 
the bowel complaints of children, the well known 
but neglected formula, that combines rhubarb with 
the sulphate of potash, being fully equal to the re- 
moval of most of the ordinary disorders of this 
class.* 

So excellent a corrector is rhubarb of vitiated 
biliary secretions, and so efficient a deobstruent, 
that I have known five grains taken once a day for 
a month, to cause nearly the entire absorption of a 
large sarcocele, dependent upon great constitution- 
al disorder. The bowels were always confined, 
the motions discoloured, the digestion bad, the 

* About ten or twelve grains of rhubarb with eight or ten 
grains of the super-sulphate of potash or sal polychrest form a 
mild and, generally, sufficiently efficient purgative for females and 
persons in delicate health. — Edit. 



OF INDIGESTION. 143 

flesh reduced, the strength greatly impaired; but 
this small quantity of rhubarb, dissolved in water, 
and taken daily an hour before dinner, produced a 
healthy flow of bile, with a sufficient and consist- 
ent alvine evacuation every day ; relieving the pa- 
tient, in every respect, in a very unexpected and 
gratifying manner. Within four weeks, by this 
simple means, the general strength was much re- 
cruited, the appetite and flesh increased, the coun- 
tenance was recovering fast its wonted healthy 
look, the local complaint appeared one-third of its 
former size, and had the patient persevered in the 
use of the rhubarb, I am persuaded he would have 
perfectly recovered ; but, feeling himself so much 
better, he neglected to continue the remedy, and 
consequently suffered a relapse. The blue pill 
had been previously given in this case, for some 
w r eeks, by a distinguished surgeon, but with results" 
far inferior to what was afterwards obtained by 
the employment of the rhubarb.* 

Ipecacuanha is another article which operates di- 
rectly, and in a very salutary way, on the internal 
surface of the stomach and bowels, and through 
them on the skin and biliary secretion, and which 

* Dr Marshall Hall thinks very favourably of the virtues of 
rhubarb in the mimoses. He observes (page 94 of the second 
edition of his Essay), that he has found rhubarb and magnesia of 
great use, when there was "diarrhoea, with scanty, fetid, and 
dark-coloured motions." — " Indeed, in all cases where the more 
active purgative medicines have been employed in the commence- 
ment, rhubarb appears to be particularly adapted, from its tonic 
properties, to complete the cure." 



144 TREATMENT 

may be advantageously given to dyspeptics, either 
alone, or combined with rhubarb. An excellent 
tonic pill is made by uniting one grain of ipecac- 
uanha with two grains of powdered rhubarb, and 
two grains of soap ; to be taken, twice or thrice a 
day. 

The tartarized antimony has an operation some- 
what similar to that of ipecacuanha, and may often 
be used with good effect, as an alterative. This 
medicine is very much used on the continent in 
bilious and gastric disorders, and is there considered 
fully capable of fulfilling the indications for which 
mercury is so commonly ordered in this country. 
It will be universally acknowledged, I presume, 
that this antimonial preparation is a remedy of no 
mean power, in cleansing the primae viae, and pro- 
moting a soluble state of the bowels, while it ex- 
erts a very salutary action on the whole cutaneous 
surface ; if, therefore, the properties of rhubarb, ei- 
ther singly, or combined wdth the emetic tartar, 
are really what they are now described, we may 
conclude that they may be often advantageously 
employed as substitutes for mercury. 

The experiments of M. Magendie, and the usual 
effects of emetic tartar upon the animal economy, 
prove that this substance exerts a specific influence 
on the mucous membranes of the alimentary canal 
and lungs, by which we are frequently able to ac- 
complish very desirable objects in morbid invasions 
of these parts. A similar influence over these or- 
gans is possessed by ipecacuanha. They both em- 



OF INDIGESTION. 145 

inently promote expectoration, determine to the 
skin, and increase the peristaltic action of the 
bowels; and if an animal is killed by an over-dose 
of the former substance, death, in every instance, 
is found to be produced by violent inflammation 
of the substance of the lungs, and of the mucous 
membrane of the alimentary canal, extending from 
the upper orifice of the stomach to the anus. The 
result is still the same, if the active principle of 
the tartarized antimony be thrown into the jugular 
vein, or be simply absorbed from any part of the 
body.* These phenomena account for the remark- 
able power often possessed by ipecacuanha and 
tartarized antimony over severe dysentery, and oth- 
er unhealthy states of the bowels, which are too 
generally looked upon as bilious: and they corro- 
borate, at the same time, the truth of the opinions 
given in this essay respecting the nature of dysen- 
tery, and of the other disorders which I believe to 
be erroneously considered as essentially connected 
with hepatic affection. Dr Balfour's Illustrations 
of the power of Emetic Tartar afford additional 
evidence in favour of my views. 

In treating those morbid affections of the diges- 
tive organs which centre in the stomach, there are 
two medicines which appear to me of great value. 
One is, the nitric acid, which, though it made a 
great noise at one time in the cure of certain dis- 

* See M. Magendie's paper on the influence of Emetic Tartar 
on man and on animals. 



146 TREATMENT 

eases, and not without reason,' seems now almost 
entirely laid aside as an internal remedy ; the other 
is Brandish's caustic alkali, a medicine but little 
known, even for what it was originally recom- 
mended (scrophula), and not at all in the maladies 
under review. 

With me, the nitric acid has repeatedly succeed- 
ed in restoring the assimilating viscera to the per- 
formance of their healthy functions, when mercu- 
ry, in every form, was either useless or injurious, 
and where no benefit accrued from the employ- 
ment of other medicines. It acts as a tonic and 
alterative to the stomach and general habit, and is 
best adapted to the cure of that modification of in- 
digestion in which the stomach and duodenum 
are chiefly concerned ; where, along with a great 
deal of debility, there is heat and pain in the epi- 
gastric region, vomiting of food, want of appetite, 
burning in the hands and feet, or of the general 
surface, and especially when, with the existence of 
these symptoms, mercury has been freely thrown 
in, under the idea of there being a "liver com- 
plaint" It strengthens the stomach and duode- 
num, and at the same time promotes their healthy 
secretions ; and from being powerfully refrigerant, 
it proves a grateful, as well as an effectual medicine, 
when morbid heat, either partial or general, inter- 
nal, or external, is a troublesome symptom. In 
slight and recent cases, it is of little or no service ; 
the severe and tedious being those in which its 



OF INDIGESTION, 147 

powers are the most conspicuous, which renders it 
the more valuable. 

It is too common a practice, in this form of the 
complaint, to give large and frequent doses of cal- 
omel as a purgative, and otherwise, when it never 
fails to sink the strength, and to excite the most 
horrible nervous sensations ; here this acid will be 
found strikingly restorative. In the beginning, it 
may be taken in doses of six drops three times a 
day, in a large wine-glassful of distilled water, 
sweetened with sugar, if agreeable, and gradually 
increased to eight or ten drops. 

The mineral acids are considered by competent 
judges, as very useful in the advanced stages of in- 
digestion ; and the nitric acid has also been praised 
for its effects in chronic inflammation of the liver, 
occurring in India ; but it has never gained that 
confidence among medical men, in the treatment 
of these complaints, that it merits, though its ac- 
tion on the skin, and its combining within itself 
the properties of a tonic, alterative, and refrigerant, 
clearly point it out as a valuable remedy. Dr 
Scott considered it, in most instances, far superior 
to mercury in the chronic hepatitis of the East. 
Its power in correcting general and local morbid 
action is apparent, from its effects in restoring the 
constitution to a measure of its former health and 
strength, after it has been impaired by protracted 
or severe courses of mercury ; and in healing the 
frightful ulcerations, so often the consequence of 
such courses, in which its efficacy is scarcely 



1 48 TREATMENT 

equalled by any known medicine. The proofs of 
its value which were elicited during the controver- 
sy that took place some years since respecting its 
antisyphilitic powers, are sufficient to convince us, 
that it demands a greater share of attention from 
the profession; and, from recent investigations into 
the nature of the ordinary syphilitic diseases, it is 
no longer doubtful whether mercury, or the nitric 
acid, is in general the safest and best remedy in 
many of these disreputable complaints. 

I have known this acid, within a week, to re- 
store, in a great measure, the skin of dyspeptics 
from the dark, sallow hue, so common in such ca- 
ses, to its natural appearance. In these patients, 
mercury had failed to produce this, or any other 
beneficial change ; but the alteration from the use 
of the acid has been so striking, as to excite the 
attention of their friends, and to be hailed by them 
as a certain sign of returning health, in which 
they were not disappointed. 

The alkali recommended by Mr Brandish, for 
the cure of scrophula, is often of signal service in 
stomachic weakness and disorder. It is decidedly 
tonic to this part, and to the whole of the alimen- 
tary canal, and operates as a permanent stimulus to 
the whole system, increasing the appetite and 
strength, and exhilarating the spirits in a remar- 
kable manner. All the alkalies are occasionally 
found of excellent use in these maladies ; they are 
efficacious correctors of morbid acidity, and have 
other effects on the stomach and bowels that are 



OF INDIGESTION. 149 

very grateful and beneficial. Reasoning from the 
healthy changes wrought by it, I should say, the 
alkaline solution of Brandish possesses every good 
quality of the most powerful alkalies, and alkaline 
earths, in common use, without their objections; 
as it possesses no deleterious property, and may be 
continued for several months in succession, not 
only without injury, which cannot always be 
avoided in prescribing the former, but with increas- 
ed advantage, both as a tonic and alterative. 

Like the foregoing acid, it is of most service 
where the stomach is the chief seat of disorder; 
but instead of being applicable to the cases where 
heat is a troublesome feeling, it is in those in 
which coldness of the feet, chilness of the general 
surface, languor, fluttering at the pit of the sto- 
mach, and morbid acidity, are the most prominent 
symptoms, that it displays its full powers. The 
acid cools while it strengthens ; this gently stimu- 
lates, and imparts an agreeable glow to the whole 
frame. It is likewise often of as much use in re- 
cent, as in old and bad cases ; and it favours the 
natural action of the bowels. 

Some persons, who suffer from intestinal weak- 
ness and disorder, or the second modification of in- 
digestion, derive much and lasting advantage from 
this alkali ; and, if I mistake not, it is much more 
exhilarating to the spirits, where it agrees, more 
strengthening also, and a more effectual alterative 
than the acid. 

Every one will acknowledge how requisite it is 
u 



1 50 TREATMENT 

to preserve and increase the strength, in advanced 
stages of these disorders, for which purpose it is 
common to prescribe light bitters and aromatics, 
in conjunction with other more efficient measures; 
on this account, the nitric acid, and the caustic al- 
kali, lay strong claim to general confidence, from 
their being at once eminently tonic and alterative, 
supporting the strength more permanently, and in 
a way far superior to bitters and aromatics, at the 
same time that they are capable of removing the 
cause of the complaint. 

Many ladies in the higher circles, who pass a 
great part of their time in large towns and cities, 
in overheated rooms, and who take little exercise, 
from these causes become pale and weak, lose their 
appetite, and are distressed with constipation of the 
bowels, and many uncomfortable sensations about 
the region of the stomach, particularly after eating; 
to such, the alkaline solution will prove a mild, 
but exhilarating and excellent tonic, that tends ef- 
fectually to remove constipation, and to restore the 
energies both of body and mind. 

At the commencement, it should be given in 
doses of a tea-spoonful morning and evening, and 
gradually increased to two tea-spoonfuls. Fresh 
beer, and milk and water, cover its taste the best ; 
and whatever it is taken in, not less than three- 
fourths of a tea-cupful should be used as a vehicle, 
since the nature of the remedy requires it to be 
diluted with a considerable quantity of some fluid. 
If beer be employed for this purpose, it should be 



OF INDIGESTION. 151 

quite fresh ; and acids of every kind, with all sub- 
acid fruits, must be altogether avoided, while tak- 
ing this alkali.* 

I would recommend this alkali to the attention 
of persons who suffer from a long residence in a 
warm climate. The chief complaint of these in- 
valids is, a deficient and irregular action of the sto- 
mach and bowels, which they will find the alka- 
line solution well adapted to remove. 

The employment of metallic tonics, and indeed 
of many other strengthening medicines, appears to 
be much feared by some late writers on indiges- 
tion, but without sufficient reason. No doubt 
many practitioners have done harm by their prema- 
ture or otherwise improper exhibition, but this 
does not in any degree militate against their utility. 
Their use is frequently contraindicated in the in- 
flammatory kind of habit or condition, mentioned 
at page 108, but in that of simple debility, describ- 
ed before it, they are generally very useful, and 
sometimes of more service than any other descrip- 

* As this alkaline solution is not generally sold by druggists, 
I have thought it advisable to mention, that it may be procured 
from Mr Watts, chemist, &c. 478, in the Strand. 

[An excellent alkaline solution may be conveniently prepared 
in the following manner. — Take, of hickory ashes, one quart, 
soot about a tea-cupful ; Pour on these a gallon of boiling water, 
and after it has stood a day or two decant or filter for use. As 
this is probably a much less concentrated preparation than the 
one recommended in the text, the dose may be at first a table- 
spoonful, and subsequently increased gradually to a wine-glass 
or tea-cupful three times a day, always diluted with at least an 
equal quantity of water.- — Edit.~] 



152 TREATMENT 

lion of medicines. Of course there is a great dif- 
ference in cases, with respect to the effect result- 
ing from the administration of particular metals. 
In some cases, iron will prove the most available ; 
in others, bismuth, and in a third class, nitrate of 
silver, or sulphate of zinc. A recent author* has 
represented the nitrate of silver as being capable of 
superseding all the other metallic tonics, but in this, 
he is, in my opinion, quite mistaken. I believe it 
is a most serviceable remedy in many cases of in- 
digestion, whose chief seat is in the stomach, but 
in at least as many, both iron and bismuth singly 
are more appropriate and useful. It will not be 
expected that I should here particularize the in- 
stances to which they are most applicable, as they 
hardly admit of description ; it is sufficient for me 
to say that they are those of debility, unaccompa- 
nied with inflammatory action. Bismuth is well 
known to be of superior value where pain in the 
stomach is a prominent symptom ; and I have rea- 
son to think it is of equal service in many cases of 
dyspepsia, where there is not much pain in that 
organ, but great local and general weakness. The 
sub-carbonate of iron appears to me to be the best 
preparation of that mineral, and rhubarb, or ipe- 
cacuan, with a minute dose of aloes, may be ad- 
vantageously joined with it.f 

* Dr Johnson, on Morbid Sensibility of the Stomach. 
t We have witnessed most admirable effects from the nitrate 
of silver in dyspeptic cases attended with great irritability of the 



OF INDIGESTION. 153 

I have not used the quinine much in dyspeptic 
cases, but, nevertheless, consider it a very servicea- 
able medicine. Its efficacy is increased by uniting 
it with rhubarb. 

The daily, or almost daily, exoneration of the 
bowels is of essential importance in all disorders of 
the digestive viscera, but this object must be ac- 
complished by very mild aperient medicine, assist- 
ed by a diet of a laxative nature. Purging, espe- 
cially with calomel, deserves severe reprobation for 
the reasons already advanced at page 117. It 
commonly excites the most distressing sensations 
in the patient, and provokes every bad symptom. 
As a gentle aperient, the following pills may be 
recommended for their mildness and efficacy. 
Aperients, given in the form of pills, are almost 
always by far the most proper in indigestion. 

R Extr: Colocynth: comp: 
Pil: Rhei comp: aa 9j 
Pulv: Ipecac: gr. vj 
01: Carui, gr. iv. 

Saponis Duri gr. xiv. M. ut fiant Pil: xij, equibus 
sumantur una vel altera, omni nocte, hora decubitus. 



stomach manifested by pain after eating, &c. We have used it 
after the following formula : 

Nitrate of Silver gr. x 

Pulv. Gum Aloes 

Ipecacuanha, of each xvi 

Denarcotized Opium iv. 

To be made into a mass by means of conserve, or other conve- 
nient substance, and divided into twenty pills, one of which may 
be taken two or three times a day. Edit. 



154 TREATMENT 

Or these, 

R Aloes Spicat: 9j 

Scammonise Pulv: gr. xv. 

Extr: Rhei 3ss 

Bacc: Capsici pulv: gr. vj 

01: Caryophill: gtt. v. Ft. pilulae xv. quarum sumat una 

vel altera, hora somni, pro re nata. 

Common saline purgatives are almost altogether 
inadmissible in these complaints. The natural sa- 
line waters of Cheltenham and Leamington are, 
however, unquestionably of great utility in many 
of the disorders now treated of, but I have reason 
to coincide in the truth of the opinions long since 
delivered, by Dr Saunders, that the valetudinary 
visitors to those places may usefully be divided 
into three classes, viz. those who gain unequalled 
benefit from the waters ; those who obtain neither 
good nor harm ; and those who suffer injury. The 
latter class are composed, principally, of persons 
who labour under stomach disorder, in every in- 
stance of which we may with certainty predict, 
that active aperients will be found extremely in- 
jurious ; and this is, for obvious reasons, especially 
the case, if the medicine be suspended in a large 
quantity of water. Therefore, those suffering from 
abdominal disorder, who resort in search of health 
to the wells of those elegant and delightful towns, 
should be careful to ascertain the nature of their 
symptoms before they venture on drinking the 
purging waters, lest they return worse than they 
went. 



& t 



OF INDIGESTION. 155 

As active purging has been so general a practice 
in these maladies, and large doses of calomel are 
thought particularly efficacious, I would here re- 
mark, how contrary this mode of proceeding is to 
that of Mr Abernethy, and Dr Hamilton, Sen. 
whose writings are so much admired by the profes- 
sion. Dr Hamilton prescribes purgative medi- 
cines to excite, but not to stimulate the bowels, and 
he combines with them, generally, unirritating 
doses of mercury. Mr Abernethy's practice is still 
more gentle ; he says — " As I have found the leni- 
ent plan of treatment (that of exciting the peris- 
taltic action of the bowels, so as to induce them to 
clear out the whole of the residue of the food, 
without irritating them, so as to produce what is 
ordinarily calMtd purging), particularly successful, 
I have rarely deviated from it." (page 70). 

In respect to the adaptation of the foregoing re- 
medies to the particular forms of indigestion de- 
scribed in the second chapter, I would observe, that 
in stomach affections, the pills of rhubarb and ipe- 
cacuan, with soap ; iron in some form ; bismuth ; 
the alkaline solution ; and nitric acid, have appear- 
ed to me the most efficacious medicines to be used 
in the day, with which, a mild mercurial alterative 
may sometimes be given at night with no small 
advantage. Mercury however, in any form, is less 
called for in this modification of the malady than 
in the second and third varieties (page 100); and 
often cannot here be borne at all. When required, 
the blue pill, combined with compound powder of 



156 TREATMENT 

ipecacuan, or rhubarb, is the best mode of giving 
it. I have witnessed the most satisfactory changes 
from using the rhubarb pill, mentioned at page 
144, during the day, with the following pill every 
night, or every second night:* — 

K Pil: Hydrargyri, gr. iv. 

Pulv: Ipecac: Comp: gr. i. M. ft. 
Pilula. 

When the small intestines seem greatly affected, 
mercurial preparations are generally very servicea- 
ble, and the following has appeared to me the most 
efficacious combination. If much pain be present, 
the quantity of opium ought to be increased a 
little, and should the symptoms be urgent, the pill 
may be ordered twice a day in the cmnmencement 
and afterwards once a day, or once in two days: — 

R Hydrarg: Submuriatis, gr. xij. 
Antimon: Tartariz: gr. i. 
Guaiaci Gum: Pulv: gr. xxiv. 
Pulv: Opii, gr. i. 
Conf: Aromat: q. s. ft. Pil: xij. 

Together with the mercurial, the tartarized an- 
timony in solution ; the rhubarb pills ; quinine ; or 
compound decoction of sarsaparilla, may be given 
during the day. The alkaline infusion of sarsapa- 

* Combined, of course, with a proper diet and regimen. 
These points I do not advert to here, as I shall presently notice 
them somewhat at length. 



OF INDIGESTION. 157 

rilla, as well as the ordinary decoction, I have 
known of great service in this form of the com- 
plaint.* The former preparation appears most 
applicable and useful when considerable debility is 
present, or where the stomach, as well as the in- 
testines, are much weakened and disordered, and 
especially if morbid acidity of the stomach is a pro- 
minent symptom. Sarsaparilla is a medicine of 
superior utility in plethoric habits, and where the 
excited form of indigestion (page 109) appears. 

In the present variety of dyspepsia, aperients are 
generally indicated, on account of the constipated 
state of the bowels usually existing. The object 
in employing aperient medicine should be to gain 
a comfortable exoneration of the bowels daily, or 
nearly so, with as little irritation as possible, as al- 
ready remarked. In every respect we ought to 
imitate the healthy operations of nature ; and, as in 
this particular, they are at the same time efficient, 
and not only unirritating, but accompanied with 
great relief, so should the discharges procured by 
medicine be as nearly as may be attended with 
similar results. But these results can never be in- 
sured, in chronic diseases, by purging. Patients 

* This alkaline solution may be prepared- in the following 
manner : 

Take of sarsaparilla root sliced and bruised, four or six ounces; 
liquorice root sliced, one ounce ; lime water, four pints. Let 
these digest together in a covered vessel for twenty-four hours, 
during which time they should be frequently stirred and shaken, 
When strained it is fit for use. About a pint of this, divided into 
three equal doses, may be taken daily,— Edit. 

V 



158 TREATMENT 

can hardly have a milder aperient pill than that 
prescribed at page 153. If they do not suit the 
patient's habit, the compound decoction of aloes, or 
a seidlitz power in warm water, may perhaps be 
found suitable. These are mild aperients of the 
very best description. 

It is in derangement of the biliary organs, that 
such mild aperients as are presented in the natural 
saline waters of Cheltenham and Leamington of- 
ten prove of the utmost service ; and with these, 
which are taken every morning, or every other 
morning, a mercurial pill at night is conjoined with 
the best effects. It must not be forgotten, how- 
ever, that tonics are in this form of the disorder 
also very generally indicated ; the most appropriate 
are rhubarb, alkaline solution and quinine. 

The nitro-muriatic acid bath, recommended by 
the late Dr Scott, is, in my opinion, of no small 
advantage in some severe affections of the liver and 
small intestines. Sometime ago I met with a most 
severe case, that demonstrated its usefulness in a 
very gratifying manner, for the patient quite reco- 
vered from a most lamentable condition by its em- 
ployment alone. In this example, ulceration, or a 
state nearly approaching to it, seemed to have 
taken place in the alimentary canal, for the patient 
had ulceration in the throat, with extreme tender- 
ness and pain in particular parts of the abdomen, 
and occasional discharges of blood and pus. 

When indigestion depends on the existence of a 
contraction in the rectum, the principal means of 



OF INDIGESTION. 159 

relief is the passing of a rectum bougie every other 
day.* An alterative pill every other night may, 
perhaps, be indicated at the same time, and some- 
times the tonic pill of rhubarb and ipecacuan, or 
the alkaline infusion of sarsaparilla. To procure a 
free evacuation of the bowels in this modification 
of the disorder, the use of the clyster machine is 
often of eminent service. The patient may throw 
up a pint of thin gruel, or linseed tea, every morn- 
ing, or four times a week, with the view of evacu- 
ating the lower bowels, without irritation. If there 
exists much irritability in the rectum, this injec- 
tion will be found very soothing and useful. In 
strictures of the rectum, some surgeons recommend 
the bowels to be rather freely acted on by mild 
aperients, during the process of cure, but accord- 
ing to my observation, this is not an eligible plan, 
on account of the irritation it occasions.! 

* For the management of this part of the cure, I must refer to 
books on Surgery. Some useful hints connected with this point 
will, however, be found in my volume on Domestic Medicine al- 
ready referred to. 

t I ought to have remarked in the second chapter, that when 
stricture in the rectum has existed for a long time, and the con- 
traction has become very considerable, the patient generally la- 
bours under peculiar nervous depression and agitation, recurring 
in paroxysms, or fits, so that he will be for a little while tolerably 
free from any unusual degree of nervousness, and then it will 
suddenly attack him with great, and sometimes an overwhelming 
force. I have lately met with two or three patients in which this 
distressing feature of the disease was very strongly marked, and 
that it entirely depended on the existence of a close contraction 
of the lower intestine was evident, from its having been quite re- 
moved by the use of the bougie alone. One of these patients used 



160 TREATMENT 

In regard to the treatment of local pain and un- 
easiness, so common in indigestion, I would observe 
that in my practice, general remedies directed to 
the fulfilment of the indications, noticed at page 
117, have almost uniformly been far the most ef- 
fectual. When pain and soreness exist at the pit 
of the stomach, or in the side, or chest, &c. it is 
very common to recommend the application of 
leeches, or the cupping glasses, with or without a 
blister; and in rather full habits, bleeding from the 
arm is not unfrequently practised for the removal 
of these symptoms ; but I am firmly persuaded that 
such measures are not generally the best, even 
when this kind of inconvenience is considerable, 
and also that they are very often attended with in- 
jurious consequences. My reasons for this opinion 
will be given in the next chapter, when referring 
to the treatment of indigestion associated with a 
fulness of blood in the head. Very often have I 
seen such symptoms quite removed, even in full 
habits, by the proper employment of the foregoing 
remedies, after blood-letting and blistering, in va- 
rious forms, had been used with only a partial and 
temporary benefit at the best, always followed by 

to be attacked by these nervous fits at night, generally after the 
candle was put out in his bed-chamber, when they would come 
on accompanied with so great a sense of oppression about the 
chest, and of suffocation, as would compel him instantly to rise 
from his bed and seek for a light, which would have the effect of 
relieving him more or less completely. Before these attacks 
commenced, this person was freer than most men from a sense of 
nervousness. 



OF INDIGESTION. 161 

some degree of injury.* The local applications 
I would advise in such cases are warm fomenta- 
tions two or three times a day, and when the ten- 
derness of the part will admit of it, frequent gen- 
tle friction with the soap liniment. 

In regard to the particular treatment applicable 
to the inflammatory or excited form of dyspepsia, 
mentioned at page 108, and to that in which sim- 
ple debility is manifested, 1 have only to remark 
here, that in the former case, we must not in the 
beginning attempt the use of direct tonics, but 
trust to the efficacy of mercurial alteratives with 
sarsaparilla, tartarized antimony, and rhubarb and 
ipecacuanha, joined with a very mild diet, and 
much exposure to country air, to improve the pa- 

* The superior value of the proper employment of alterative 
medicine, with a correct diet and regimen, in these cases, was 
particularly exemplified in the case of a dissenting clergyman, 
whom I lately visited. This gentleman is decidedly of a full 
habit, and has been labouring under indigestion for three or four 
years, accompanied with almost constant pain across the stomach, 
which frequently attacked also the side and chest during the win- 
ter months. He had been often bled, leeched and blistered, at 
intervals, for the removal of these symptoms, without any satis- 
factory or permanent benefit, although medicines were likewise 
given internally at the same time. It appeared to me that the 
principles of preserving the strength unimpaired, and of soothing 
local irritation, had not been sufficiently attended to in this case, 
and therefore the patient gained no real and lasting advantage 
from the treatment pursued under more than two or three differ- 
ent practitioners ; and if the results of another mode of proceeding, 
founded on the principles above inculcated, may be considered as 
conclusive on the subject, this was a correct view of the state of 
the case, for the patient perfectly recovered in three months from 
the adoption of this method. 



162 TREATMENT 

tient's condition, and so to augment his strength 
that he may be able to bear quinine, bismuth, iron, 
&c. and have his recovery thereby established.* 

Diet has always been considered a subject of no 
small moment in the treatment of the present com- 
plaint. The grand maxim with regard to it is, to 
eat and drink sparingly, at stated intervals, and of 
food the most digestible, and that agrees best with 
the individual. No bilious or dyspeptic person 
should eat more than four times a day, and those 
periods ought to be, as near as possible, at regular 
intervals of four or five hours ; say eight, twelve, 
four, and nine o'clock. It is a common, but very 
erroneous and injurious supposition, that such pa- 
tients ought to eat little and often 5 because by 
taking food in this way, scarcely two hours elapse 
throughout the whole day without something be- 
ing swallowed, by which means the stomach has 
no time for the perfect digestion of the previous 
meal, and is kept in a constant state of irritation 
and disorder. No rest is given to it, and therefore 
instead of gaining strength, it loses it. It may be 
safely received as a general rule, that food should 
not be taken in the intervals of meals, and a want 
of this kind will seldom be felt by those who ad- 
here to the hours just mentioned.! 

* See the directions at page 406 of my Modern Domestic Me- 
dicine. 

t This testimony is at direct variance with the opinion express- 
ed in the often repeated saying of the late Dr Rush, that u the 
stomach, like a school boy, was always in mischief when idle.— - 
Edit, 



OF INDIGESTION. 163 

Where a considerable degree of hardness exists 
in the pulse, with much feverish heat generally, 
an inflammatory tendency exists in the system, 
when a diet wholly vegetable, and even a total ab- 
stinence from wine, must, for the most part, be ob- 
served, and is strikingly beneficial. The best ve- 
getables are, turnips, brocoli, French beans, aspara- 
gus, and potatoes ; no other should be taken. In 
this state of the complaint, light, plain puddings 
are allowable, but pastry is altogether inadmissible 
in every description of case. 

In the greater number of instances, however, 
the hardness of pulse just noticed is not present, 
and then an animal diet is the best. Mutton, ve- 
nison, lamb, and tender beef, are the most whole- 
some and digestible of meats ; and next to these 
come partridge, pheasant, fowl, chicken, and hare* 
Of either of these, a small quantity roasted and 
little done may be taken at dinner, it being seldom 
proper for a dyspeptic to eat animal food more than 
once a day. The flesh of full grown animals is to 
be preferred to that of young ones, and I know no 
exception to this rule. Some medical men, how- 
ever, have gone so far, and erred so widely, as to 
assert the reverse of this to be the truth, but they 
are blind leaders. Preference has, indeed, been 
given to veal over beef, by some physicians of great 
judgment, who agree as to the superior digestibi- 
lity of the flesh of full grown animals in general ; 
but, according to my experience, it is a preference 
that ought not to be maintained, for I have found 



164 TREATMENT 

few articles of diet more indigestible and irritating 
than veal, and, therefore, in my practice, it is uni- 
versally forbidden to those of weak digestive pow- 
ers. Full grown tender mutton and venison are 
unquestionably the most digestible, and best of all 
meats. All salted and dried meats is inadmissible, 
and boiled fresh meat of any kind is not quite free 
from objection in severe indigestion. Excepting 
oysters in their natural state, every sort of fish is 
bad in the present disorder, and must be altogether 
avoided, at least in the beginning. 

In common language, fish is called a light arti- 
cle of diet, but it is an error to suppose it to be 
easy of digestion. It is given to patients convales- 
cent from acute diseases, in preference to flesh, not 
because it admits of a more ready solution in the 
stomach, but on account of its exciting less heat 
and fever. Both vegetable and animal food done 
a second time is very objectionable, and, therefore, 
hashes, harricoes, stews, and the like, must make 
no part of the dyspeptic's cookery. In all cases, 
plain biscuit is preferable to white bread, but well- 
made brown bread is better than either, when the 
bowels are confined, and there is strength of sto- 
mach sufficient to take it. 

Generally speaking, all slop fluids are much more 
difficult of digestion than solids, and a weakened 
stomach is quite incapable of digesting even the 
ordinary quantity which is taken in health with 
satisfaction and benefit. It is for this reason that 
broths and soups are injurious to most dyspeptics^ 



OF INDIGESTION. 165 

and that drinking too freely of soup, tea, and the 
like, will sometimes throw such persons almost 
into agonies. They should therefore be abstained 
from as much as possible. 

Port wine is almost invariably hurtful, but a 
little foreign white wine taken after dinner, is 
sometimes useful. The best wine is old sherry, 
but with some patients good claret answers very 
well. If wine cannot be taken, a little weak bran- 
dy and water may sometimes be tried, but it is 
what I should seldom recommend, and ought in 
all cases to be changed for wine or beer, as soon as 
possible. Mild home-brewed beer generally agrees 
better than wine or brandy. It ought not to be 
strong ale, which is at all times difficult of diges- 
tion 5 neither should it be poor weak beer, but that 
of a moderate strength or body. There exists a 
general prejudice against the use of beer in indi- 
gestion and bilious complaints, but I cannot help 
thinking it is, in the majority of instances, without 
substantial foundation. If patients are properly 
treated, they will, in general, find good beer to 
agree very well. To quench thirst in the inter- 
vals of meals, nothing can be found equal to soda 
water : it is exceedingly grateful and effectual, and 
that made with the soda powders appears to me to 
be much better than the bottled water.* For the 

* The best soda water is made with toast and water, instead 
of plain water. The toast has so much of a softening quality, 
that it imparts an additional spirit to the soda water prepared in 
W 



1 66 TREATMENT 

partial or general heat and feverishness so often 
present in this malady, it is an appropriate and effi- 
cient draught, and in the summer is particularly 
useful. It should then be constantly drank in pre- 
ference to any other liquid. Well made toast and 
water is likewise a proper drink, and so is lemon 
or orange tea, that is, lemon or orange-peel infused 
in boiling water. The latter possesses a stimulus 
which is very useful to some disordered stomachs. 

Tea, cocoa, or thin chocolate, made with water, 
may be taken for breakfast, and at tea-time ; with 
biscuit, bread and butter, or dry toast. Rolls, and 
all other spongy bread, are bad ; and coffee must 
be wholly forsaken. One fresh lightly-boiled egg 
may be taken at breakfast, if it agrees. Whatever 
liquid is taken in the morning and evening, the pa- 
tient should not exceed a common breakfast-cupful 
at each time. 

The supper should be very light, and small in 
quantity, consisting of a roasted apple, or potatoe, 
or an egg lightly boiled, with a biscuit, or some 
bread and butter. In summer, a little good ripe 
fruit in season will make a very wholesome supper. 
A small tumbler full of mild beer may likewise be 
allowed if it agrees, and the portion of food then 
taken be solid. Some dyspeptics find well-made 
grit or oatmeal gruel, with or without milk, to 
form an agreeable and wholesome supper. 

this manner, and renders it both more agreeable to the palate, and 
more grateful to the stomach. In winter, the water should be 
lukewarm. 



OF INDIGESTION. 167 

The food should be well masticated, and quiet- 
ness, with rest, observed for at least half an hour 
after each meal, Digestion almost invariably pro- 
ceeds much better in a sitting, than in a recumbent 
position. 

The Scotch oat-cake is wholesome, and very easy 
of digestion, and many dyspeptics will find great 
advantage from frequently eating it (when they can 
get it) instead of bread. Its aperient qualities are 
an additional recommendation. 

Dr Johnson has strongly recommended (in his 
Essay on Morbid Sensibility of the Stomach) 
water gruel as a very nutritious unirritating species 
of food for dyspeptics, and he seems to think it uni- 
versally of superior value in such cases. -» In this 
advice it appears to me that he has not sufficiently 
considered the difference existing between that 
form of indigestion (see page 108) in which a state 
of general excitement or inflammatory tendency is 
conspicuous, and that where debility exists without 
this tendency. In the former cases, no doubt such 
gruel is a most useful food, but in the latter, which 
are by far the most common examples, it is not 
found suitable, on account of its speedily acidify- 
ing, and thus proving oppressive and irritating. 
In these latter cases, gruel made with a large pro- 
portion of good beer, instead of water, will be found 
particularly easy of digestion, and very nutritious. 
For the majority of dyspeptics, it forms the most 
wholesome article for supper that I am acquainted 
with. 



I 68 TREATMENT 

As, contrary it would seem to the sentiments of 
professional men in general, I consider good malt 
liquor the most friendly to the human constitution 
of all fermented liquors, perhaps I ought here to 
remark farther on this point, that it is the hase 
quality of that article, as now generally or univer- 
sally sold, that has brought it into so much disre- 
pute. No man can answer for the effects of the 
stuff usually sold as beer ; but good home-brewed 
beer of a moderate strength will be found to suit 
the majority of dyspeptics uncommonly well, agree- 
ing better than wine, since it is far less disposed to 
acescency, and better fitted to act as a stomachic, 
and therefore to invigorate both the digestive organs, 
and the Constitution at large.* 

If malt liquor will not agree, I recommend the 
use of soda water, or toast and water, made as above 
directed. 

A correct Regimen is of the utmost consequence, 
and a strict and constant attention to it is absolute- 
ly necessary in order to obtain a perfect cure. All 
sedentary occupations must be forsaken as much 
as possible, and if they can be entirely given up, 
the prospect of complete relief will be far greater. 
Indeed, considerable and permanent advantage can 
only be obtained, in the majority of instances, by 
relinquishing in a very great measure all such en- 

* The infusion of hop, contained in all good beer, is a very 
useful bitter tonic, that tends to strengthen the stomach, and in- 
vigorate the whole frame. 



OF INDIGESTION. 169 

gagements, and quitting the confined atmosphere 
and late hours of the crowded city, for the pure, 
dry, bracing air of the country, with its early ris- 
ing, and active exercises. It is the common neg- 
lect of such a regimen that makes indigestion so 
rarely and imperfectly cured; for where a high 
state of chronic debility, and nervous irritability, 
has been induced by long continued exposure to 
the depressing effects of confinement, and intense 
application to business, literary pursuits, or plea- 
sure, no medicine, nor even diet, can be employed 
w r ith much effect as a substitute for country air, 
daily active exercises, cheerful company, and early 
rising. The patient should quit his bed by six 
o'clock in the morning in the summer, and by se- 
ven in the winter ; and after partaking of a light 
breakfast, take exercise freely for two or three 
hours before dinner. After dinner, gentle exer- 
cise should be again taken for an hour or two. Of 
all exercises, those of walking and riding on horse- 
back are the most beneficial, and, where the pa- 
tient's means and strength allow, they should be 
used alternately ; but when the strength is much 
reduced, horse exercise is almost invariably to be 
preferred. 

The power of daily active exercise* in the open 

* The following observations respecting the value of exercise, 
in my Treatise on the Art of Prolonging Life, refer to a point 
which appears to me so worthy of attention, both from the public 
and profession at large, that I would beg leave to insert them 
here. — " I would here bespeak the reader's attention to the dif- 



1 70 TREATMENT 

air in curing indigestion is very great, indeed such 
as would appear to the majority of persons almost 
incredible ; and, therefore, it cannot be too much 

ferent sections of this chapter, and more especially to that which 
adverts to the excellent and various uses of exercise ; being con- 
vinced that while all these subjects are but too little attended to, 
and their value too imperfectly known, that of exercise demands 
particular regard, on account of its remarkable effects on health 
and longevity. To all invalids it is a subject of the highest mo- 
ment. None will accuse me of undervaluing the advantages re- 
sulting from attention to diet, in the cure of disease ; but it is 
proper for me to state, that there appears to me one grand point 
of superiority which exercise in the open air possesses, in this res- 
pect, over even diet, which is, that it is capable of exerting a direct 
and positive curative effect, while the effects of diet, in the same 
circumstances, are rather negative than positive. In using pro- 
per food, when afflicted with any corporeal malady, we cut off a 
principal source of irritation, and take an effectual means of nour- 
ishing and strengthening the body, and thereby of assisting nature 
in its efforts to free the constitution from an unwelcome and op- 
pressive visitor 5 but beyond this the virtues of suitable food can 
scarcely be said to extend. On the other hand, exercise has often 
a direct and powerfully curative effect, from its accelerating and 
equalizing the circulation, when tardy and irregular, from its also 
strengthening the vessels and nerves, facilitating the excretions, 
and greatly improving the tone of the digestive organs. From a 
consideration of these facts, we see the reason why a correct diet 
should often fail to do little more than preserve the patient from 
getting worse, and that an efficient regimen is found absolutely 
necessary to produce much positive amendment, or to perform a 
sound and lasting cure. To illustrate this subject still further, 
we may advert to the case of a person suffering under severe chro- 
nic gout, or an aggravated attack of indigestion, and we shall of- 
ten find, that if such patients attentively observe a suitable diet, 
they gain much advantage : but if they go a little beyond this at- 
tention to diet, supposing it is even combined with skilful medi- 
cal treatment, the gouty man, in numerous instances, is still very 
liable to frequent fits of his tormenting disease, and will not 
unfrequently find himself getting more feeble, and the fits to gain 



OF INDIGESTION. 171 

insisted upon by the physician, as an indispensable 
requisite to insure perfect freedom from this com- 
plaint. Many medical men lay great stress upon 
attention to diet, as necessary in the treatment of 
this and other chronic diseases, and so it is ; no one 
acquainted with my writings will suspect me of 
undervaluing it, but I am fully persuaded that re- 
gimen is of still greater moment, and experience 
proves, that exercise is the most essential branch 
of the athletic regimen. I am disposed to think 
that exercise is not so strenuously recommended as 
it ought to be, or its virtues so fully known as they 
deserve. 

Cheerful company and enlivening conversation, 

an increasing power over him ; while the dyspeptic experiences 
weakness of stomach, and general debility remaining, with a 
liability to a renewal of his disorder, on the operation of slight 
causes. But should these patients become convinced of the value 
of regimen, in the sense now attached to it, and enter into its 
adoption with spirit and perseverance, they very soon discover 
that they are using means which have a superior and remarkable 
power in resolving obstructions, and in so facilitating and regulat- 
ing all the secretions, and imparting an increase of tone to every 
function of the body, as to afford them a most flattering prospect 
of being at length enabled entirely to conquer their disease. Un- 
der the operation of this regimen, the gouty sufferer finds his 
crippled limbs to become free and strong, his digestive powers to 
be augmented, and his spirits surprisingly exhilarated ; and the 
dyspeptic bilious subject experiences an equally beneficial change 
[ in the increased tone of his stomach and bowels, in the more 
healthy secretion of bile, the keenness of his appetite, and the 
greater quantity of food he can take, not only with a relish, but 
without the uneasiness he before felt severely from indulging in a 
much smaller quantity ; effects which both have found diet and 
medicine could only partially produce." 



172 TREATMENT 

with proper clothing, are also subjects of impor- 
tance. The feet and chest should be kept especi- 
ally warm, and if the debility be great, with a con- 
siderable reduction of the natural heat of the body, 
a flannel waistcoat worn next the skin during the 
colder months will be very proper. The bed 
clothes should be no more than sufficient to keep 
the patient comfortably warm, and a mattress is 
always preferable to a feather-bed. 

The value of a pure air in dyspeptic cases being 
universally known, need not be insisted on. A 
dry bracing air is generally required. 

As an auxiliary remedy, the tepid bath merits 
attention. Some people suppose the warm bath to 
be relaxing, but when properly used in the present 
disorder, it generally proves very refreshing and 
strengthening. From 90 to 95 degrees is the best 
range of heat for dyspeptics, and the proper time 
for resorting to the bath is in the morning, between 
breakfast and dinner ; the patient using it three or 
four times a week, and remaining in it from twenty 
to thirty minutes, according to his feelings, which 
ought to be comfortable on his coming out. A 
gentle walk or ride should follow it when the 
weather permits. 

Where the warm bath cannot be conveniently 
obtained, or it fails to be beneficial, tepid sponging 
should be substituted. The whole surface of the 
body should be sponged regularly every morning 
with tepid water, the patient rubbing himself dry 



OF INDIGESTION. 173 

after it with a coarse towel. This is a very re- 
freshing and salutary practice. 

The internal use of the warm waters of Buxton 
and Bath are occasionally of great service. They 
relieve pain and uneasiness in the stomach, and 
often eminently promote digestion. The late Dr 
Saunders of London thought highly of tepid water 
as a remedy in this complaint, and questioned 
whether drinking the water at the celebrated 
springs of Buxton would, upon trial, be found 
more efficacious in these complaints, than the re- 
gular use of the same quantity of any pure water 
heated to the same temperature. Those who wish 
to try it may take a small tumbler-full after dinner 
and supper. For pain or uneasiness in the sto- 
mach, occurring after dinner, or any other solid 
meal, the addition of a tea-spoonful or a tea-spoon- 
ful and a half of strong tincture of ginger to the 
tepid water will prove of great benefit. 



174 



CHAPTER V. 



OF TIC DOULOUREUX, NERVOUS DISORDER, &c. AS CONNECTED 
WITH INDIGESTION. 



No enlightened practitioner can long attentively 
pursue the study and practice of medicine, without 
being impressed with the great and extensive influ- 
ence exercised by the digestive functions over other 
parts of the human frame ; indeed, so marked and 
important is this influence, that there is scarcely a 
disease, not originating in mechanical injury, which 
does not own derangement of these functions as its 
foundation, either in its origin or continuance. 
Commonly it is the sole foundation both of acute 
and chronic complaints ; while the smaller number 
which have had another origin, are still so greatly 
dependent on the integrity of these functions for 
their perfect removal, that when this fact is over- 
looked, it often becomes the source of a protracted 
cure. If therefore we were about to treat, as a 
late author (Dr Uwins) has proposed to himself, 
of the diseases either directly or indirectly con- 
nected with indigestion, we should be proposing to 
ourselves a most arduous task, as it would in re- 
ality be to treat of almost all the maladies incident 






OF TIC DOULOUREUX. 175 

to the body. It is consequently not my intention 
to enter here on any such undertaking, but I have 
a few remarks to offer on the subjects of tic dou- 
loureux, nervous disorder, gout, and fulness of blood 
in the head, which it is hoped may not be unac- 
ceptable to my readers. 

Fifty years ago tic douloureux was almost un- 
known ; now it is frequently met w 7 ith. I do not 
see how there can consistently be more than one 
opinion, on the subject of its nature and origin, for 
it is to me evident, that it has grown with the 
grow T th of stomachic and intestinal irritation, and 
strengthened with their strength. Yet some phy- 
sicians appear disposed to regard it almost as an 
independent affection, founded in some peculiar 
disease of the teeth, or nerves. Opinions lead to 
practice, and they are no further deserving of no- 
tice than as they tend to practical results, good or 
bad. Now if a practitioner considers this malady 
to be, for the most part, depending on the irrita- 
tion of a diseased tooth or gum, or of the nerve af- 
fected, it necessarily follows that his practice will 
correspond w 7 ith his sentiments, and thus, in my 
opinion, his patient will greatly suffer from the 
employment of inappropriate and inefficient means. 
That local irritation of a nerve may* occasionally 
be the cause of tic douloureux, no one will deny, 
but that it is internal disorder, which is the ordi- 
nary cause of the malady, is equally certain. All 
the cases of tic douloureux which I have seen or 



176 NATURE AND TREATMENT 

heard of, had great disorder of the general health 
most evident. 

Therefore, local means of relief will in this dis- 
order be very generally altogether unavailing, and 
those only can succeed which are calculated to ful- 
fil the general indications noticed in the last chap- 
ter, as those which directly tend perfectly and per- 
manently to restore the patient's general health, 
when the morbid sensibility of the nervous system, 
giving rise to this peculiar affection will cease. 
Although the influence of severe derangement in 
the digestive organs, in producing excessive nerv- 
ous irritation and pain is so evident, yet I have 
been frequently greatly surprised at the slight con- 
sideration given to this fact, by respectable profes- 
sional men. They have taken different views 
respecting the origin and proper treatment of the 
cases of tic douloureux on which they were con- 
sulted, but all (to whom I refer) have tacitly 
agreed on the point, in the rejection of which alone, 
they assuredly ought not to have differed — that of 
overlooking the fact just mentioned. It is from 
this cause that so many of such patients fail to gain 
the relief which medical aid is capable of affording 
them, for although iron, quinine, &c. are very val- 
uable remedies in many instances of the present 
affection, they cannot reasonably be expected to 
succeed in all, or even the majority, any more than 
that they should be attended with success in the 
majority of dyspeptic affections. There is likewise 
a middle path taken by many persons, in reference 



OF TIC DOULOUREUX. 177 

to the management of this disease, in which it is 
treated as in a measure dependent on the internal 
derangement explained above, the treatment being 
partially conducted on this principle. The relief 
gained is consequently also partial. The reason of 
this is, that in aggravated cases (and this remark is 
applicable to all diseases), we often find that it is 
only by a corresponding close attention to the 
foundation of the malady, and by following up un- 
deviatingly the advantages gained by such atten- 
tion, that we can succeed in their perfect removal. 
This is a point worthy of much regard, for I have 
seen many patients suffer long and severely, from 
a neglect of it. 

I have no intention of offering here any particu- 
lar treatment for this very painful malady. Cases 
of tic douloureux differ much from one another, 
perhaps as greatly as cases of indigestion, and in its 
details the treatment must ever be left to the judg- 
ment of the practitioner, guided by the principles 
I have endeavoured to lay down. 

The preceding remarks are equally applicable to 
the nature and treatment of Nervous Disorder and 
Gout. They are both founded in derangement and 
weakness, or oppression of the assimilating organs, 
and therefore the most effectual mode of treatment 
is invariably that which most speedily and per- 
fectly removes this disorder and oppression. I now 
notice these complaints solely with the view of 
impressing on the reader's mind, the absolute ne- 
cessity of an unreserved and continued attention to 



178 OF GOUT. 

the principles above described, in order to their 
perfect cure. It is surprising what gratifying and 
unexpected changes are often wrought in the 
gouty man's condition, by such a cordial and un- 
reserved attention. For want of it many become 
martyrs to gout or nervousness, who really have 
the means of perfect restoration within their 
reach.* 

* I yesterday heard of an elderly gentleman, who had received 
the most gratifying relief in gout, from taking soda, by the advice 
of a surgeon in the country. This gentleman had started on a 
journey, but finding the gout coming on, he returned home, and 
sent for his surgeon. He was advised to take soda freely (in 
what way I dont know), with the view of improving the state of 
the stomach ; which most unexpectedly put an end to the gout 
and he was almost immediately enabled to proceed on his journey. 
The patient thought it marvellous, and is so publishing the extra- 
ordinary virtues of soda wherever he goes, that some think the 
surgeon may make his fortune by the patients flocking to him from 
this recommendation. The circumstances connected with this 
affair clearly illustrate an error too common among both patients 
and practitioners, and which it has been my endeavour in the 
preceding pages to guard them against — namely, that of overlook- 
ing principles, and dwelling on insulated facts. Soda is no doubt 
sometimes a valuable medicine in gout, and the old gentleman re- 
ferred to happened to find it peculiarly efficacious at the time he 
took it ; but certainly the generality of patients will not find it so 
useful, and he himself may probably be disappointed in its opera- 
tion the next time he takes it. It is natural for the patient, who 
has received signal benefit from a particular medicine, to extol it 
above its merits, but the practitioner ought not to be thus deceiv- 
ed. He ought to be influenced only by principle, and then he 
will find himself capable of being generally useful to his patients; 
while those, who lie at the mercy of insulated facts, only happen 
occasionally to strike the mark they aim at. 

[We cannot withhold an expression of our most cordial assent 
to the views and opinions embraced in this most valuable note.- — 
Editr\ 



■ 



FULNESS IN THE HEAD. 179 

Fulness of blood in the head is a symptom 
which is often found in persons suffering from in- 
digestion, especially in the young and plethoric, 
and it is one liable to prove very troublesome. 
That the circulation should often be disturbed by 
disorder of the assimilating functions, cannot ap- 
pear at all surprising, when we recollect how 
marked an influence these functions have over 
every other part of the frame ; and that an undue 
influx of blood to the head particularly should re- 
sult from this disorder, is no more than we might 
reasonably expect, from the close connexion exist- 
ing between that part and the stomach, and the 
very large proportion of blood sent constantly to 
the brain, by the internal carotid and vertebral ar- 
teries, — a quantity perhaps correctly calculated at 
nearly one-tenth of the whole mass.* 

This symptom not unfrequently proves very in- 
corrigible, but I am constrained to say, that this is 
a state which ought not to be, provided the patient 
will adopt the use of proper measures. It has al- 
ways appeared to me, that the reason why it so 
commonly proves difficult of cure is, because 
blood-letting, blistering, and purging, the means 
usually employed for its removal, are unsuitable 
and inefficient. Indeed, they are not only inap- 
propriate and ineffectual, but they too often increase 
the evil they were designed to remove, an effect 

* Some physiologists reckon it at one-eighth of the whole mass 
of blood. 



180 FULNESS OF BLOOD 

that might be anticipated, if the general principles 
of treatment explained in the last chapter are cor- 
rect. For they teach us not only studiously to avoid 
every expedient which is either directly or indi- 
rectly debilitating, but also as constantly to employ 
measures of an opposite character, that is, those 
which are capable of imparting strength generally 
and locally. Now it is certain that blood-letting and 
purging cannot ordinarily augment the strength of 
an individual. Then why, it may be asked, are 
they commonly resorted to in the present case ? 
The source of this error has been pointed out at 
the 1 08th, and following pages. It lies in the foun- 
dation, or cause of this symptom, which is debility, 
being disregarded. 

Since debility and disorder is the cause of this, 
and almost all other undue determinations of blood 
to particular structures, I therefore strongly object 
to the abstraction of this fluid for their cure, and 
also to the use of purgatives. The principles on 
which they are used appear to me erroneous, and 
the results of the practice are, according to my ob- 
servation, almost uniformly bad. I have repeatedly 
seen such local congestions of blood removed, by 
acting on the invigorating principles already so 
often adverted to, which were scarcely relieved for 
a time, by the measures above objected against. 
This is equally true of the symptom as occurring 
in young plethoric habits, and in those where debi- 
lity was well marked. Nevertheless, I do not wish 
it to be understood, that I object to cautious local 



IN THE HEAD. 181 

bleeding in such cases under all circumstances; on 
the contrary, I believe there may be instances, in 
which a small bleeding or two may be practised 
with advantage. These cases are, how r ever, com- 
paratively rare. 

In weakly persons I would recommend for the 
cure of this symptom, tonics, especially mineral to- 
nics, and very mild aperients, with the general diet 
and regimen detailed in the fourth chapter. For 
young full habits, mercurial alteratives, combined 
with a full dose of tartarized antimony, a correct 
diet, and daily active exercise. Mineral tonics will 
sometimes be very useful here also; even arsenic 
may occasionally be given with admirable effect. 
The curative power of exercise is very great, but 
it requires to be followed up with energy. A man 
under the active exercises of the training system, 
soon loses all giddiness and fulness in the head. 



183 



APPENDIX 

BY THE AMERICAN EDITOR. 



For a few years past, medical and even popular 
writers have found so fruitful atopic in dyspepsia, 
that we have been greeted with something new upon 
it almost daily. A treatise on the subject over which 
but a few months may have passed, must there- 
fore appear somewhat in the back ground, unless 
special means have been applied to bring it forward. 
Regarding the preceding publication as peculi- 
arly valuable, more especially so to our medical 
brethren, we design to remedy in some degree the 
deficiency alluded to by superadding to it the latest 
intelligence upon the subject, such at least as ap- 
pears to us most interesting either from its novelty 
or intrinsic value. We shall begin by noticing a 
little volume lately published by Dr Avery of New 
York with the title of the Dyspeptic's Monitor, 
which recommends itself by many sensible views, 
especially those relating to regimen. 

The writer appears to have had very ample op- 
portunities of acquiring information upon the 
subject of which he treats, for he tells us that hav- 
ing long been a prey to distressing symptoms of 



184 APPENDIX 

dyspepsia, over which medicine seemed to possess 
little or no control, he left an extensive country 
practice, crossed the Atlantic, and spent some time 
in visiting different parts of Great Britain and the 
Continent, collecting all the information in his 
power in regard to the ailments with which he was 
afflicted. 

Dr Avery divides dyspepsia into three species, 
though stages, we think, would have been the most 
proper designation, as the symptoms which mark 
them follow each other in train as the morbid 
irritation extends itself from its primitive seat 
to involve other parts. The first derangement 
ordinarily observed, is confined to the gastric func- 
tions proper, without any material disturbance in 
those of the other abdominal viscera : The second 
includes affections of other portions of the intesti- 
nal canal, accompanied by what are often denomi- 
nated bilious symptoms : The third, a morbid sen- 
sibility or irritability of the lining membrane of 
the stomach and bowels, attended with sympathetic 
derangements of the liver, nervous system, &c. 
Now all these w r e regard as consecutive stages, the 
last being necessarily attendant on the second, and 
this again upon the first. We of course except 
those cases of disorder of the digestive functions 
consequent upon lesions of other organs, such for 
instance as those of the liver and spleen. 

Dr Avery refers the symptoms of his second 
species to a vitiated condition of the bile without, 
as we think, sufficient grounds. Either the effect 



BY THE AMERICAN EDITOR. 185 

may be mistaken by him for the cause, or, what is 
still more probable, that which he denominates 
"tenacious, ropy bile," is more properly what the 
pathologists of the physiological school would con- 
sider an altered secretion from a mucous membrane 
in a state of disease. 

The pages which treat of the causes of indiges- 
tion contain many sensible though not very novel 
remarks. Some of these are particularly applica- 
ble to patients in this country. He strongly re- 
probates the mode of living common in the United 
States, and ascribes the greater prevalence of dys- 
pepsia here than in Europe chiefly to our very 
variable climate and the inordinate consumption of 
animal food. He inveighs particularly against our 
hearty mode of breakfasting, which he says is 
equivalent to dining in England, and expresses his 
conviction that it occasions more weak stomachs 
than can be well imagined. The labourer who 
has risen early and spent some three or four hours 
in active employment, may feel no inconvenience 
from the practice, but with those who lead seden- 
tary or inactive lives, early and full breakfasting 
cannot be long continued with impunity. He ar- 
gues that there is no necessity for nourishment un- 
til the energy accumulated during sleep is partially 
exhausted by exercise, and considers the feeling of 
appetite as the criterion by which the stomach is 
known to be in a condition to discharge its func- 
tions properly. The doctor's sketch of an Ameri- 
can breakfast was doubtless intended as a carica- 



186 APPENDIX 

ture. It must be confessed that in steam boats, 
public inns and boarding houses, the a la fourchette 
system is carried pretty far, but the tables of res- 
pectable private families exhibit much more mode- 
ration and good taste. We are moreover somewhat 
heterodox in regard to the doctor's notions of the 
sad effects of breakfasting. It is well know r n, that 
in the good olden time, before dyspepsia came into 
fashion, even the court ladies breakfasted upon beef, 
ale and such like substantial fare. We w r ould not 
however be understood as advocating unlimited in- 
dulgence in breakfasting, being in favour of mode- 
rate meals on all occasions. 

Dr Avery inveighs also, and we think very pro- 
perly, against the habitual use of spirituous liquors 
and their usual accompaniment, tobacco, as fruitful 
sources of indigestion. We are almost ashamed to 
acknowledge that we are the only civilized nation 
who do not regard the practice of chewing tobacco 
as exceedingly vulgar. If, however, we are not 
greatly deceived, the use of tobacco is rapidly de- 
clining among those who pay the least regard to 
the proprieties of life. Cigars are now scarcely 
ever introduced at private dinner parties after the 
ladies have retired, as was the common practice but 
a few years since. 

The transient vigour imparted to the stomach 
by alcoholic drinks when taken after a meal, has 
often led to their habitual use by persons with 
weak powers of digestion. This is indeed a very 
prevalent vice, and cannot be too strongly reproba- 



BY THE AMERICAN EDITOR. 187 

ted. The frequent application of all unnatural 
stimulants necessarily leads to derangements of the 
natural functions, and we entirely agree with Dr 
Avery in the opinion that, though the stomach 
may at first be goaded on by them to vigorous ex- 
ertions, it must finally be wearied out and sink 
into languor and torpidity, and we may add, what is 
still worse, driven into inflammation which may 
terminate in disorganization. The effects of spir- 
ituous liquors taken when the stomach is empty, 
are even more immediately injurious than when 
taken with the food. 

As to the treatment of dyspepsia, the author of 
the "Monitor" agrees with Dr Graham, and we 
believe all others who have had much to do with 
the disease, in regarding the exhibition of medi- 
cines as but a secondary consideration, since, with- 
out a proper diet, no permanent advantage is to be 
looked for. The impaired tone of the stomach 
cannot be recovered unless by the removal of one 
of the most frequent causes leading to it, namely, 
the habit of overloading it. Food should never be 
taken without a natural appetite, and the stomach 
is never to be forced when it shows no voluntary 
inclination. Great care must at the same time be 
observed, to restrain that morbid craving for food 
which so frequently proceeds from corroding aci- 
dity or other causes, and constitutes a great annoy- 
ance to the dyspeptic. 

In cases attended with great acidity, many au- 
thorities have united in recommending a diet 



188 APPENDIX 

composed almost exclusively of animal food. " All 
vegetables," says Dr Paris, "should be withdrawn 
and a diet of animal food substituted." This re- 
commendation, which has always appeared to us 
highly inconsistent and injudicious, we are very 
glad to find condemned by Dr Avery, whose 
conclusion, that the stomach bears that kind of food 
best which excites it least and requires the shortest 
time for its digestion, accords altogether with our 
own observation. Bread, milk, rice and such like 
articles, will, we are confident, be generally found 
to check the redundancy of acidity which would 
most probably be kept up by a diet of the most 
tender and digestible animal food. The bread taken 
with milk or any other fluid nourishment, should be 
plain and stale. It must not be broken into the 
liquid, but chewed separately in its dry state, so 
that it shall be well mixed with the saliva. We 
have been long in the practice of laying particular 
stress upon this last direction. In the early stages 
of dyspepsia a milk diet will generally be found 
extremely beneficial, and those who cannot take it 
at first without considerable inconvenience, will, 
after a few days' perseverance, find it not only to 
suit their stomachs, but become agreeable to the 
taste. About half a pint will do for breakfast, and, 
should the appetite call for it, a similar quantity 
for supper. At dinner it may generally, be eaten 
as freely as desired, provided the stomach be not 
oppressed or feel too much distended. Both tea 
and coffee should, if possible, be avoided. If weak, 



BY THE AMERICAN EDITOR. 1S9 

Dr Avery thinks that, like all hot drinks, they 
prove debilitating to the stomach, whereas if strong, 
they irritate its nerves, and give rise to a secretion 
of thin mucous and subsequent acidity. 

In cases not so aggravated as to render animal 
food altogether improper, a small piece of boiled 
mutton, roast beef, or boiled fowl may be eaten at 
dinner. Mutton is thought to be most easily di- 
gested when taken cold. The fatty parts should 
always be avoided. Boiled rice or stale bread are 
the most suitable accompaniments, and no more 
drink should be taken than is actually required, 
water or milk being the most proper, and those in 
small quantities at a time. This plan should be 
persisted in until the stomach will bear a more 
liberal allowance without unpleasant feelings. In- 
dulgence in fruits is very properly proscribed by 
Dr Avery. Such dyspeptics as can partake of 
them at all, must limit themselves to a very mod- 
erate quantity of such as are ripe and most whole- 
some. 

For the purpose of neutralizing the acid, which 
is often a very troublesome accompaniment of this 
stage, Dr Avery recommends, in addition to a well 
regulated diet, the employment of magnesia, pre- 
pared chalk and the alkalies, and more especially 
the carbonate of soda. Whenever there is a sen- 
sation of gnawing at the stomach, a copious flow of 
saliva, flatulency and other symptoms of acidity 
about a teaspoonful of the carbonate of soda may 
be taken, dissolved in half a tumbler full of water 9 



1 90 APrENDIX 

and repeated as frequently as the symptoms shall 
render it necessary. From a trial of both articles, 
we should prefer the alkaline solution mentioned 
in the preceding part of this treatise. Neverthe- 
less we have known good effects from the carbonate 
and bicarbonate of soda. They are far more 
agreeable to the palate than the carbonates of potash. 
The lozenges prepared of the bicarbonate of soda 
constitute a very convenient and agreeable form of 
employing the medicine. Those sold in the 
French shops under the name of D'Arcet's alkaline 
digestive pastils, have long enjoyed very high celeb- 
rity. They contain about five per cent of the bi- 
carbonate, to ninety five of sugar, united by means 
of mucilage of gum tragacanth and flavoured with 
a very minute quantity of essence of mint. 

For the relief of certain symptoms supposed to 
proceed from biliary derangement, such as restless- 
ness at night, disposition to doze through the day, 
weariness in the back and limbs, Dr Avery recom- 
mends a perseverance in the use of cathartics till the 
symptoms shall have disappeared. As these symp- 
toms occur so frequently without being associated 
with any such derangements, this and other rea- 
sons that could be assigned, induce us to think the 
advice injudicious. That it is at variance with the 
views maintained in the preceding treatise, is very 
evident. 

In the treatment of the second species, or, as we 
would call it, stage of dyspepsia, which, as we have 
already said, is characterized by a long train of 
symptoms ordinarily denominated bilious, such as 



BY THE AMERICAN EDITOR. 191 

yellowness of the tongue in the morning, bitter 
taste, sallowness of complexion, &c. &c, his efforts 
are not only directed to the regulation of the sto- 
mach, but likewise of the bowels and liver. The 
diet which he considers best suited to the stomach 
and least likely to promote irritation in the liver, 
is that already mentioned, consisting of one or other 
of the farinacea, but more especially oat meal gruel, 
which may in general be taken without dislike for 
a longer time than any thing else of the kind. 
From half a pint to a pint of this, seasoned with a 
little salt, or sugar, and sometimes a very little nut- 
meg, may be taken three times a day. Should the 
too frequent use of this occasion any dislike, it may 
occasionally be omitted, and arrow root, rice water, 
or Indian meal gruel substituted. The patient is 
exhorted not to be alarmed at the apparently scan- 
ty allowance proposed, since it may be strictly per- 
severed in for weeks with none but the happiest ef- 
fects. A little milk may be sometimes added to the 
gruel, but this is only admissible under peculiar 
circumstances, as for example, where exercise is 
taken in the open air. Individuals who can avail 
themselves of these last advantages may dine on 
oatmeal gruel, and if they choose, breakfast and 
sup upon a piece of stale bread, toasted or not, as 
they like, with a cup of very weak black tea. 
Among the means recommended by Dr Avery for 
obviating or correcting a confined state of the bow- 
els, an inconvenience so commonly complained of 
by dyspeptics and most persons who lead sedentary 



192 APPENDIX 

lives, is the bread of unbolted flour, or what be re- 
gards as still better, rye bread. But the article 
which he thinks will least frequently disappoint 
expectation is a thin mush made of rye flour, to be 
eaten once or twice a dav with molasses. He like- 
wise recommends an injection of half a pint of 
cold water to be used every day just before visiting 
the water closet. We think the quantity of fluid 
here mentioned rather larger than necessary, one 
or two ounces thrown up by means of a small sy- 
ringe generally answering every purpose. Observa- 
tion has taught us to regard this as one of the most 
convenient and best means that can be resorted to 
for obviating costiveness arising from a sedentary life. 
It is especially adapted to cases attended with those 
sensations of itching and crawling at the extremity 
of the bowel which are sometimes so annoying. 

In a treatise under the title of "Pathological and 
Practical Researches on Diseases of the Stomach, 
the Intestinal Canal, the Liver, and other Viscera 
of the Abdomen," by Dr John Abercrombie of 
Edinburgh,* we find, among much other valuable 
matter, some sensible remarks in relation to dys- 
peptic complaints. Of these he recognizes as the 
least conjectural, first, a form originating from defi- 
ciency of action in the muscular coat, occasioning 
too long a detention of the alimentary matters fol- 
lowed by imperfect changes and chemical decom- 
positions : Secondly, a form arising from an irrita- 

* Edinburgh, 1828, pp. 396, 8vo. 



BY THE AMERICAN EDITOR. 193 

ble state of the mucous membrane, leading to ex- 
citement of the muscular coat, and producing an 
evil precisely the reverse of that just mentioned, 
namely, either speedy rejection of the food by vom- 
iting, or its propulsion downwards in an imper- 
fectly digested state: And thirdly, a form in which 
there is deficiency in the quantity, or alteration in 
the qualities of the fluids of the stomach. 

Among the most important views presented by, 
Dr Abercrombie on this topic are the following : 
Considering the muscular action of the stomach as 
more vigorous when the contents of this organ are 
in smaller quantity than where there is much dis- 
tention, and supposing that the secretions are regu- 
lated by the quantity of ingesta they have to act 
upon, he lays it down as a first and great principle 
in the treatment of indigestion, that the quantity 
of food should be so restricted that no more be ta- 
ken than the stomach is found capable of digesting 
in a healthy manner. If it is found that the di- 
gestive process is carried on slowly, particular care 
should be observed not to take additional food until 
full time has been allowed for the solution of the 
former. For example, if the healthy period be as- 
certained to be four or five hours, the dyspeptic 
should allow six or seven. This is one of our au- 
thor's golden rules, by no means to be infringed 
upon, and it perfectly accords with the views 
maintained in the preceding treatise. The quan- 
tity of the articles taken as food, though usually re- 
garded as the most essential consideration in the 



194 APPENDIX 

treatment of dyspepsia, Dr Abercrombie thinks of 
minor importance when compared to quantity. 
He believes, in fact, that the dyspeptic might be 
almost regardless of any attention to the quality of 
his diet, if he rigidly observed the necessary res- 
trictions as to quantity. He at the same time dis- 
approves of a mixed diet. " It is often remarkable," 
says he, " how articles which cannot be borne as a 
part of mixed diet, agree perfectly when taken 
alone; how a person, 'for example, who fancies that 
milk disagrees with him, will enjoy sound digestion 
upon a milk diet, and how another, who cannot 
taste vegetables without being tormented with aci- 
dity, will be entirely free from acidity on a vege- 
table diet." 

As one of the chief objects we contemplated in 
referring to Dr Abercrombie's treatise was to show 
his pathological views, we shall say nothing of his 
medical treatment of dyspeptic complaints. We 
have taken it for granted, here as well as elsewhere, 
that nearly every thing essential upon this last 
head, has been anticipated in Dr Graham's treatise. 
It has appeared to us that the frequent success 
which has attended the Halsteadean practice of 
champooing andsuccussationof the abdomen, tends 
to support Dr Abercrombie's views in relation to 
the deficient action of the muscular coat of the 
stomach and bowels. We do not mean to say that 
these view r s furnish a rationale of this lately so fa- 
mous process, completely satisfactory, but that they 
go further to elucidate its effects than any others 



BY THE AMERICAN EDITOR. 195 

we have met with in books. It is evident that we 
are not of the number of those disposed to ridicule 
and contemn the practice of Mr Halstead, now no 
longer a secret. On the contrary, we think this 
gentleman has conferred an obligation upon his 
countrymen by making them acquainted with an 
agent known, for the most part, to people of other 
nations from time immemorial, and the advantages 
of which, under proper circumstances, it might 
argue great prejudice or dullness to deny. 

The treatment recommended by Dr Graham in 
dyspeptic cases, attended with pain and soreness of 
the pit of the stomach, consisting of warm fomen- 
tations over that region, with frequent gentle fric- 
tion, corresponds strikingly with a part of the plan 
introduced by Mr Halstead. 

Dr Graham, as we have seen, conducts his treat- 
ment of dyspepsia upon the principle of studiously 
avoiding every expedient calculated to be either 
directly or indirectly debilitating, such as blood- 
letting, purging, &c, and the employment of mea- 
sures of an opposite character capable of imparting 
strength both generally and locally. The same 
view seems to be maintained by Mr Halstead, who 
never restricted his patients in diet, or enjoined 
forbearance in any case. On the contrary, the sto- 
mach was urged on every day to some new trial of 
its strength, and the boastful reports made by pa- 
tients of their gormandizing experiments were list- 
ened to with silent approbation. This last prac- 
tice, so contrary to the dictates of common sense, 



196 APPENDIX 

and differing so widely from the judicious course 
of regimen recommended by Dr Graham, must 
have proved highly injurious to the cause of Mr 
Halstead, inasmuch as it doubtless often prevented 
recoveries, aggravated symptoms, and produced re- 
lapses. We are speaking of his early practice, 
when he was in the full tide of experiment, and 
before the publication of his book, in which we are 
glad to find a reference made to "the dictates of 
common sense," and an acknowledgment that 
hardly any case can be relieved without some at- 
tention to diet. He has even gone so far as to lay 
down three dietetic rules, the first of which is, to 
eat slowly ; the second, to eat moderately ; and the 
third, to eat at regular periods. He dispenses 
altogether with the employment of internal re- 
medies. 

In the preface to his publication, Mr Halstead 
professes to give a full narrative of the manner m 
which he was led to adopt his "new method of 
curing dyspepsia." We would observe, by the 
way, that this preface of some half dozen pages, is 
perhaps the only portion of the duodecimo which 
came from Mr Halstead's pen. The rest, exclusive 
of the description of the organs and process of di- 
gestion, which is acknowledged to be taken from 
the Library of Useful Knowledge, has undoubtedly 
been prepared by a professional hand. We shall 
not of course be suspected of mentioning this in 
disparagement. The narrative alluded to repre- 
sents, that having for more than twenty years suf- 



BY THE AMERICAN EDITOR. 197 

fered all the evils of dyspepsia in its most aggra- 
vated forms, and exhausted every means of cure 
he had heard of, without success, he finally had 
his attention specially directed to the state of ex- 
treme hardness and unnatural rigidity of his abdo- 
men, with the increased tension and spasmodic 
contractions in the abdominal muscles during the 
paroxysms of the disease. Convinced that a great 
deal of his distress was somehow or other connect- 
ed with these conditions, and struck with the re- 
lief always obtained from travelling day and night 
in stages, in which he often slept, he says that he 
came to the conclusion that during the time he 
was asleep the abdominal muscles became relaxed 
and the agitation was communicated to his sto- 
mach and bowels in the manner which nature 
seemed to require for their relief. Satisfied with 
this reasoning, he next set about devising some 
means by which he might procure a relaxation of 
the rigid muscles and give a jolting sort of motion 
to the stomach and bowels. In accordance with 
these views, he was led to relax the abdominal 
muscles during exercise ay an exertion of the will, 
and says that he was thus enabled to derive the 
full benefit of those exercises which had previously 
failed in affording any relief. From this it may 
be inferred that the chances of obtaining advantage 
from either walking or riding are greatly dimin- 
ished or entirely lost if the person be maintained 
in an erect position, in which the abdominal mus- 
2a 



1 98 APPENDIX 

cles are necessarily in a state of what Mr Halstead 
denominates, involuntary contraction. That the 
stomach may receive the agitation so indispensably 
necessary, a perfect relaxation must be procured, 
which can only be effected by stooping forward or 
settling down. How this accords with the notions 
of those who, in the pursuit of healthy exercise, 
w T ould not abandon all pretensions to grace, we leave 
to be determined by the persons whom it may con- 
cern. Mr Halstead tells us, however, that after this 
discovery he soon found that every one had not the 
same voluntary control over the muscles of the 
abdomen that he himself had. That these muscles 
are subject to the will in some but not in others, 
we must confess sounds to our ears as rather equi- 
vocal, since we, and we believe all our professional 
brethren, have been taught to regard them as ap- 
pertaining most decidedly to the voluntary class. 
This discovery, it must be observed, is related in 
the preface. For the reasons already given, it 
could not have been expected in any other portion 
of the book. 

After this sketch of the deductive philosophy by 
which, according to his printed account, Mr Hal- 
stead was led to adopt his new mode of curing 
dyspepsia, we shall attempt to convey some idea of 
his process. We have alluded to his book account, 
because w r e had heard a very different story of its 
origin previously to his publication. 

It has been already stated that Mr Halstead lays 
particular stress upon the outward condition of the 






BY THE AMERICAN EDITOR. 199 

abdomen. For the purpose of producing relaxa- 
tion in the abdominal muscles, without which 
there can be no hope, he advises the external ap- 
plication of w r arm fomentations, poultices, steam- 
ing, &c, to be repeated two or three times a day. 
He particularly recommends the application, on 
going to bed, of flannel cloths wrung out of a mix- 
ture of equal parts of hot vinegar and water. 
These should be several times folded so as to retain 
the warmth and moisture, and sufficiently large to 
extend from the chest to the hips. Upon this a 
coarse dry towel may be spread, and then a bottle 
filled with hot water, or what is still more conve- 
nient, a warm flat-iron, passed gently over the 
whole abdomen for fifteen or twenty minutes. 
After the removal of the wet cloths, a piece of 
warm, dry flannel should be substituted. This 
process may be repeated two or three times a day, 
and the best time is when the stomach is empty. 
In this way we are assured the abdomen may ge- 
nerally in a few days, be rendered soft and yield- 
ing, the sense of constriction removed, the respira- 
tion rendered more free and easy, and the patient 
made altogether more comfortable. Sometimes, 
however, a much longer persistence is requisite to 
produce the desired effects. Should this plan of 
fomentation be found to occasion exhaustion, it 
ought to be omitted for a day or two, and on being 
resumed not continued so long each time. We 
have read the letter of an American gentleman, 
detailing the manner in which he was relieved in 



200 APPENDIX 

Paris from a most inveterate case of dyspepsia. 
It was of course written prior to Mr Halstead's 
"discovery." "The only medication employed/' 
says the writer, "was external, by means of hot 
sulphurous baths every other day, continued from 
three-quarters of an hour to an hour; jets or 
douches of steam, or hot water, upon the stomach 
and bowels on alternate days, and a cataplasm of 
flaxseed or bread, applied to the bowels every 
night."* 

The application of poultices, fomentations, &c. in 
diseased states of the abdominal viscera is in fact 
as old as the practice of medicine ; and in France, 
especially where the doctrines of Broussais have 
any influence, it is resorted to in almost every 
case of dyspepsia. The rationale of this plan of 
treatment is much more satisfactory as explained 
by the French authorities than by the one whom 
we are now considering. The effect produced on 
the rigid muscles of the abdomen is but partial, 
and that from which the least benefit is derived. 
It is by its relaxing effects generally and more par- 
ticularly by its influence on the skin that it is use- 
ful in dyspeptic cases. The intimate connexion 
subsisting between the functions of the skin and 
those of the chylopoietic apparatus is well under- 
stood by physicians. 

The next step in the plan of cure is the com- 
munication of a certain mechanical action to the 

* Professor Hitchcock's Lectures, Appendix. 



BY THE AMERICAN EDITOR. 201 

stomach, which process comprises the pith and mar- 
row of the "new method." In this operation the 
patient is usually placed with his back to the wall, 
having his w T aistbands loosened and his abdomen 
without any other covering than a shirt or other 
thin garment. The operator seated immediately 
before him, places his hands on the lower margin 
of the ribs, and with his thumbs or index fingers 
presses just beneath the breastbone in the pit of the 
stomach, so as to cover the spot usually possessing 
the most sensibility. The pressure is to be gradu- 
ally increased, and should it occasion more uneasi- 
ness than can be conveniently borne, may be 
suspended. Sometimes however there is so much 
insensibility, that the strongest pressure which can 
be made by a stout man using all his force gives 
no pain or uneasiness. 

When this is the case recourse is had to sudden 
tapping or punching with the finger and thumb 
over the point indicated. This part of the process 
has received the technical appellation of "the 
shock." It is to be commenced gently and repeat- 
ed once or oftener every day until the sensibility 
be restored. A sudden sensation of pain darting 
upwards towards the throat or in other parts, as the 
back and limbs, is often perceived to follow these 
strokes upon the stomach, and when this happens, 
it is regarded as a good omen. The more tender 
the spot pressed upon or punched becomes, the 
more rapid the cure, and the sensibility once 
awakened must not be suffered to subside entirely, 



£02 APPENDIX 

but kept up by the patient, who with his finger or 
thumb is to press upon it with sufficient force and 
frequency. 

As tenderness in epigastrio is one of the most 
characteristic symptoms of acute inflammation of 
the stomach, it is easy to conceive that the effects 
of punching for the purpose of promoting this 
condition might be attended with very disastrous 
consequences. This part of the practice we think 
ought never to be resorted to without the advice 
of a physician. 

The next step in the process is to communicate 
an impulse to the stomach of a jolting kind, which 
in the Halsteadean phraseology is called " the ac- 
tion." This is done either by the patient himself 
or an operator. The last is generally to be pre- 
ferred, and is effected most conveniently in the fol- 
lowing manner. The operator seated on the right 
of the patient places his right hand firmly upon 
the lower part of the bowels in such a manner as 
apparently to get below them, and hold them rest- 
ing upon the upper edge of his hand. Then by a 
succession of upward movements he produces a 
kind of succussation very much like that which 
takes place on horseback or in a jolting vehicle. 
This action on being kept up for a minute or two 
commonly produces a sensation of warmth and 
general excitement, with a feeling at the stomach 
which has been compared to a slight electric shock. 
Among the good effects resulting from this process 
is relief from flatulency when this has been a trou- 



BY THE AMERICAN EDITOR. 203 

blesome symptom. The flatus is expelled by ac- 
tual mechanical force dexterously applied to each 
hypochondriac region, which is certainly far better 
than the common mode of correcting it by inter- 
nal means, the subsequent effects of which are 
often highly detrimental. Though the operation 
may create slight uneasiness or pain at first, it be- 
comes rather pleasant after a few repetitions. 

Another method, by which nearly the same ef- 
fects may be produced, is to place the patient 
against a wall with his body so inclined as to relax 
the abdominal muscles, in which position the ope- 
rator seated before him places his hands upon the 
abdomen, and pressing firmly makes a quick suc- 
cession of rubbing motions upwards. In doing this 
the ends of the fingers are frequently punched 
under the stomach, so as to give rise to that tender 
and peculiar sensation which has been mentioned 
as desirable to produce and promote. This opera- 
tion may be carried on so that by moving the hands 
gradually downwards, the succession of small 
shocks may be imparted to the stomach by impul- 
ses made on the lower parts of the abdomen. 

When the patient is to operate on himself, he 
must incline his body forwards so as to favour as 
much as possible the relaxation of the abdominal 
muscles. Then placing his hands in a horizontal 
position in such a manner as that the ends of the 
fingers may meet just below the pit of the stomach, 
he inclines the palms upwards, so as to get them, as 
it w T ere, beneath the stomach, and makes the same 



204 APPENDIX 

kind of quick upward movement which has been 
already described. The hands may be applied 
lower and lower until, as before mentioned, the 
succussion is communicated to the stomach from 
the lowermost parts of the abdomen. These se- 
veral operations are recommended to be continued 
from one to five minutes each time, and repeated 
frequently during the day; sometimes indeed, where 
there is a great degree of torpor, as often as every 
half hour. It would, we think, be improper to 
employ these mechanical means immediately after 
eating, as Dr Avery recommends, and the best time 
for resorting to them is in general about an hour 
or two after a meal. The intervals between the 
applications should be gradually lengthened, so that 
two or three applications a day may be sufficient, 
and finally the process may be superseded by other 
kinds of exercise. 

It cannot be denied, that by the means just de- 
scribed, the most salutary effects have been pro- 
duced in cases of dyspepsia. Those who have 
undergone or witnessed the process must be satis- 
fied that the agent is one of a most positive 
character. One who has not had such an exhibi- 
tion could scarcely believe it possible for the ab- 
dominal viscera to bear the mechanical violence, to 
which they are frequently subjected under the 
Halsteadean discipline. We have heard of cases 
where the utmost strength of an uncommonly 
sturdy man was applied in sudden punches over 
the pit of the stomach. Some patients in despair 



BY THE AMERICAN EDITOR, £05 

of rousing the sensibilities of their torpid stomachs 
by the ordinary methods, have even resorted to 
pushing themselves violently against canes and 
sticks posted against the wall. And yet we are 
informed that out of many hundred cases there 
has not been an instance of injurious effects ensu- 
ing. This experience is, we think, calculated to 
perplex in no small degree the ordinary reasoning 
of pathologists. That operators possessing no pro- 
fessional knowledge should have gone on so long 
without encountering cases of supposed dyspepsia 
depending upon acute inflammation, scirrhous or 
other organic affections, where these mechanical 
applications must have inevitably proved detrimen- 
tal and dangerous, is to be ascribed to nothing short 
of the most unexampled good fortune. 

The influence, which this practice is calculated 
to produce upon the muscular, nervous, sanguine- 
ous and lymphatic capillary systems involved in 
the various organs of the abdominal cavity, offers a 
subject for interesting enquiry. As the manual 
exercise exacted is neither suited to the taste nor 
leisure of most physicians, it is not at all likely 
that they w T ill contest the field with the Halstea- 
dean operators, who, should the practice gain a 
permanent footing, will perhaps be referred to in 
the same manner as the bleeders, leechers and 
other subsidiaries of the profession. 

We shall conclude our notice of Mr Halstead's 
practice with some remarks of Dr Avery, in which 
we entirely concur. « Let not the professed gour- 
2b 



206 APPENDIX. 

mand, the idle epicure, nor even the book worm, 
the accountant, or delicate female, who never ex- 
ceed one twenty-fourth of their time in active ex- 
ercise in the open air, flatter themselves that 
shampooing will enable them to eat with impunity 
the hearty food that is proper for the labourer 
only. It may be usefully added to a proper regi- 
men, but is good for nothing without it. In this 
respect it stands in the same light with every other 
remedy. To suppose it applicable to all cases of 
dyspepsia is as absurd as to imagine that any one 
medicine will cure all diseases. Mustard seed and 
brandy have both in their turn been considered as 
specifics. The first is now and then useful, the 
second never." 

During the last year, a work under the title of 
Dyspepsia Forestalled and Resisted has been pub- 
lished by Professor Hitchcock of Amherst College. 
It consists of a series of lectures on diet, regimen and 
employment, delivered to the students of that in- 
stitution, and embraces a very large fund of infor- 
mation upon those subjects, the result of much ob- 
servation and extensive research. As might be 
expected, it will be found more interesting to the 
general reader than to the physician, and the ad- 
vocates of moderation and temperance have a 
zealous and very able advocate in Professor Hitch- 
cock. 












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